Surgical tool

ABSTRACT

A medical instrument comprising: (a) a first joint comprising a first member and a second member, the first member configured to be repositionable with respect to the second member in a first degree of freedom; (b) a second joint operatively coupled to the first joint, the second joint comprising a third member and a fourth member, the third member configured to be repositionable with respect to the fourth member in a second degree of freedom; (c) a pair of repositionable jaws operatively coupled to the first joint and the second joint; (d) an occlusion clip detachably mounted to the pair of repositionable jaws; and, (e) a controller operatively coupled to the first joint, the second joint, and the pair of repositionable jaws, the controller including a first control configured to direct repositioning of at least one of the first member and the second member, and a second control configured to direct repositioning of at least one of the third member and the fourth member, and a third control configured to direct repositioning of the pair of repositionable jaws.

The present disclosure is directed to medical instruments and, morespecifically, to an applier that may be used to apply a left atrialappendage occlusion clip.

It is a first aspect of the present invention to provide a medicalinstrument comprising: (a) a first joint comprising a first member and asecond member, the first member configured to be repositionable withrespect to the second member in a first degree of freedom; (b) a secondjoint operatively coupled to the first joint, the second jointcomprising a third member and a fourth member, the third memberconfigured to be repositionable with respect to the fourth member in asecond degree of freedom; (c) a pair of repositionable jaws operativelycoupled to the first joint and the second joint; (d) an occlusion clipdetachably mounted to the pair of repositionable jaws; and, (e) acontroller operatively coupled to the first joint, the second joint, andthe pair of repositionable jaws, the controller including a firstcontrol configured to direct repositioning of at least one of the firstmember and the second member, and a second control configured to directrepositioning of at least one of the third member and the fourth member,and a third control configured to direct repositioning of the pair ofrepositionable jaws.

In a more detailed embodiment of the first aspect, the first controlcomprises a first active control configured to be repositionable amongan infinite number of positions, where each of the infinite number ofpositions orients the first member with respect to the second memberwithin the first degree of freedom, and the second control comprises asecond active control configured to be repositionable among an infinitenumber of positions, where each of the infinite number of positionsorients the third member with respect to the fourth member within thesecond degree of freedom. In yet another more detailed embodiment, thefirst active control includes a first wheel around which is partiallywound a first wire operatively coupled to at least one of the firstmember and the second member so that rotation of the first wheeltranslates into movement of at least one of the first member and thesecond member, and the second active control includes a second wheelaround which is partially wound a second wire operatively coupled to atleast one of the third member and the fourth member so that rotation ofthe second wheel translates into movement of at least one of the thirdmember and the fourth member. In a further detailed embodiment, themedical instrument further includes a repositionable lock in selectivecommunication with at least one of the first control and the secondcontrol to retard movement in at least one of the first degree offreedom and the second degree of freedom. In still a further detailedembodiment, the repositionable lock is in selective communication withboth the first control and the second control to retard movement of thefirst joint in the first degree of freedom and the second joint in thesecond degree of freedom. In a more detailed embodiment, the firstcontrol includes a plurality of first teeth, the second control includesa plurality of second teeth, and the repositionable lock includes acatch that concurrently engages at least one of the plurality of firstteeth and at least one of the plurality of second teeth. In a moredetailed embodiment, the controller is operatively coupled to ahand-held housing, and the repositionable lock is repositionably mountedto the hand-held housing. In another more detailed embodiment, the firstcontrol is operatively coupled to a hand-held housing and includes atleast one of a pivoting, a sliding, and a rotating first projectionextending from the hand-held housing, the second control is operativelycoupled to the hand-held housing and includes at least one of apivoting, a sliding, and a rotating second projection extending from thehand-held housing, and the repositionable lock is operatively coupled tothe hand-held housing and includes at least one of a pivoting, asliding, and a rotating third projection extending from the hand-heldhousing. In yet another more detailed embodiment, the first controlincludes a rotating first projection that comprises a first wheel, thesecond control includes a rotating second projection that comprises asecond wheel, the repositionable lock includes a sliding thirdprojection. In still another more detailed embodiment, the medicalinstrument further includes a longitudinal conduit extending between thecontroller and the first joint.

In yet another more detailed embodiment of the first aspect, the firstmember comprises a clevis, and the second member comprises a universal.In yet another more detailed embodiment, the universal includes at leastone of a first cavity and a first projection, as well as at least one ofa second cavity and a second projection, the clevis includes the otherof at least one of the first cavity and the first projection, as well asthe other of the second cavity and the second projection, the firstprojection is configured to be repositionable within the first cavity,and the second projection is configured to be repositionable within thesecond cavity, in order to allow repositioning of the clevis withrespect to the universal within the first degree of freedom. In afurther detailed embodiment, the third member comprises the universal,and the fourth member comprises a linkage housing. In still a furtherdetailed embodiment, the universal includes at least one of a thirdcavity and a third projection, as well as at least one of a fourthcavity and a fourth projection, the linkage housing includes the otherof at least one of the first cavity and the first projection, as well asthe other of the second cavity and the second projection, the thirdprojection is configured to be repositionable within the second cavity,and the fourth projection is configured to be repositionable within thethird cavity, in order to allow repositioning of the universal withrespect to the linkage housing within the second degree of freedom. In amore detailed embodiment, the medical instrument further includes afirst connection extending along the longitudinal conduit connecting thefirst control to at least one of the first member and the second member,and a second connection extending along the longitudinal conduitconnecting the second control to at least one of the third member andthe fourth member. In a more detailed embodiment, the medical instrumentfurther includes a third connection extending along the longitudinalconduit connecting the first control to at least one of the first memberand the second member, and a fourth connection extending along thelongitudinal conduit connecting the second control to at least one ofthe third member and the fourth member. In another more detailedembodiment, the first connection, the second connection, the thirdconnection, and the fourth connection each comprise a wire. In yetanother more detailed embodiment, the controller further includes afourth control configured to detachably mount the occlusion clip to thepair of repositionable jaws. In still another more detailed embodiment,the fourth control includes a wire concurrently mounted to the occlusionclip and the pair of repositionable jaws.

In a more detailed embodiment of the first aspect, the wire comprises atleast a first wire and a second wire, the first wire is concurrentlymounted to the occlusion clip and a first of the pair of repositionablejaws, the second wire is concurrently mounted to the occlusion clip anda second of the pair of repositionable jaws, the fourth control isrepositionable to selectively dismount the first wire from at least oneof the occlusion clip and the first of the pair of repositionable jaws,and is repositionable to selectively dismount the second from at leastone of the occlusion clip and the second of the pair of repositionablejaws. In yet another more detailed embodiment, the fourth controlincludes a tab mounted to the first wire and the second wire, and thetab is selectively detachable from a hand-held housing. In a furtherdetailed embodiment, the tab is rotationally repositionable with respectto the hand-held housing. In still a further detailed embodiment, themedical instrument further includes a first connection extending alongthe longitudinal conduit and operatively coupling the third control tothe pair of repositionable jaws. In a more detailed embodiment, themedical instrument further includes a folding support that isconcurrently mounted to the pair of repositionable jaws and the fourthmember of the second joint, the folding support repositionable between afolded position and an unfolded position, where the folded position hasthe pair of repositionable jaws in closer proximity to one another thanin the unfolded position. In a more detailed embodiment, the foldingsupport is operatively coupled to a pulley and the first link. Inanother more detailed embodiment, the folding support includes: (a) afirst link concurrently repositionably and operatively coupled to afirst of the pair of repositionable jaws; (b) a second link concurrentlyrepositionably and operatively coupled to a second of the pair ofrepositionable jaws; (c) a third link concurrently repositionably andoperatively coupled to the first of the pair of repositionable jaws andthe second link; and, (d) a fourth link concurrently repositionably andoperatively coupled to the second of the pair of repositionable jaws andthe first link, where the third link is repositionably and operativelycoupled to the fourth link.

In a more detailed embodiment of the first aspect, the folding supportincludes a fifth link concurrently repositionably and operativelycoupled to a sixth link and to the first link, wherein the sixth link isconcurrently repositionably and operatively coupled to the fifth linkand to the second link. In yet another more detailed embodiment, thefifth and sixth links are both mounted to and repositionable withrespect to a pulley. In a further detailed embodiment, the second jointincludes a first camming surface to facilitate repositioning of thefifth link, and the second joint includes a second camming surface tofacilitate repositioning of the sixth link. In still a further detailedembodiment, the first connection is operatively coupled to the fifth andsixth links. In a more detailed embodiment, the first connectionincludes a pulley operatively coupled to the fifth and sixth links. In amore detailed embodiment, the third control comprises a repositionablehandle operatively coupled to a hand-held housing of the controller. Inanother more detailed embodiment, the third control includes a slide armconcurrently mounted to the repositionable handle and the firstconnection. In yet another more detailed embodiment, the third controlincludes a spring to bias at least one of the slide arm and the handle,and the third control includes a trigger to selectively unlock theorientation of the handle with respect to the slide arm. In stillanother more detailed embodiment, the first wire comprises a first pairof wires partially wound around the first wheel, where the first pair ofwires is mounted to the second member, and the second wire comprises asecond pair of wires partially wound around the second wheel, where thesecond pair of wires is mounted to the third member.

In yet another more detailed embodiment of the first aspect, the firstwheel around which the first pair of wires are partially wound aroundhas a first diameter, the second wheel around which the second pair ofwires are partially wound around has a second diameter, where the firstdiameter is larger than the second diameter. In yet another moredetailed embodiment, the folding support comprises a folding pantographsupport.

It is a second aspect of the present invention to provide a method ofcontrolling an end effector of a medical instrument, the medicalinstrument including a hand-held device operatively coupled to the endeffector, comprising: (a) providing a first control of the hand-helddevice configured to direct repositioning of at least one of a firstmember and a second member of a first joint of the end effector, thefirst member and second member being repositionable with respect to oneanother in a first degree of freedom; (b) providing a second control ofthe hand-held device configured to direct repositioning of at least oneof a third member and a fourth member of a second joint of the endeffector, the third member and fourth member being repositionable withrespect to one another in a second degree of freedom different from thefirst degree of freedom; and, (c) providing a third control of thehand-held device configured to direct repositioning of a folding supportbetween a compact position and an expanded position, the folding supportconnecting the first and second joints.

In a more detailed embodiment of the second aspect, the method furtherincludes providing a fourth control of the hand-held device configuredto selectively disengage an occlusion clip operatively coupled to thefolding support. In yet another more detailed embodiment, the firstcontrol includes a first wheel having a first wire partially woundtherearound, where the first wire is also operatively coupled to atleast one of the first member and the second member of the first jointof the end effector, and the second control includes a second wheelhaving a second wire partially wound therearound, where the second wireis also operatively coupled to at least one of the third member and thefourth member of the second joint of the end effector. In a furtherdetailed embodiment, the third control includes a repositionable handleoperatively coupled to the hand-held device, the repositionable handleoperatively coupled to a wire that is operatively coupled to the foldingsupport to allow repositioning of the folding support between thecompact position and the expanded position.

It is a third aspect of the present invention to provide a medicalinstrument end effector comprising: (a) a first joint comprising a firstmember and a second member, the first member configured to berepositionable with respect to the second member in a first degree offreedom; (b) a second joint operatively coupled to the first joint, thesecond joint comprising a third member and a fourth member, the thirdmember configured to be repositionable with respect to the fourth memberin a second degree of freedom; and, (c) a pair of repositionable jawsoperatively coupled to the first joint and the second joint by a foldingsupport.

In a more detailed embodiment of the third aspect, the end effectorfurther includes an occlusion clip detachably mounted to the pair ofrepositionable jaws. In yet another more detailed embodiment, the endeffector further includes a controller including a first controlconfigured to direct repositioning of the first joint, a second controlconfigured to direct repositioning of the second joint, and a thirdcontrol configured to direct repositioning of the pair of repositionablejaws, and a longitudinal conduit extending between the controller andthe first joint. In a further detailed embodiment, the first membercomprises a clevis, and the second member comprises a universal. Instill a further detailed embodiment, the universal includes at least oneof a first cavity and a first projection, as well as at least one of asecond cavity and a second projection, the clevis includes the other ofat least one of the first cavity and the first projection, as well asthe other of the second cavity and the second projection, and the firstprojection is configured to be repositionable within the first cavity,and the second projection is configured to be repositionable within thesecond cavity, in order to allow repositioning of the clevis withrespect to the universal within the first degree of freedom. In a moredetailed embodiment, the third member comprises the universal, and thefourth member comprises a linkage housing. In a more detailedembodiment, the universal includes at least one of a third cavity and athird projection, as well as at least one of a fourth cavity and afourth projection, the linkage housing includes the other of at leastone of the first cavity and the first projection, as well as the otherof the second cavity and the second projection, the third projection isconfigured to be repositionable within the second cavity, and the fourthprojection is configured to be repositionable within the fourth cavity,in order to allow repositioning of the universal with respect to thelinkage housing within the second degree of freedom. In another moredetailed embodiment, a wire concurrently mounts the occlusion clip tothe pair of repositionable jaws. In yet another more detailedembodiment, the folding support is concurrently mounted to the pair ofrepositionable jaws and the fourth member of the second joint, thefolding support repositionable between a folded position and an unfoldedposition, where the folded position has the pair of repositionable jawsin closer proximity to one another than in the unfolded position. Instill another more detailed embodiment, the folding support isoperatively coupled to a pulley and the first link.

In yet another more detailed embodiment of the third aspect, the foldingsupport includes: (a) a first link concurrently repositionably andoperatively coupled to a first of the pair of repositionable jaws; (b) asecond link concurrently repositionably and operatively coupled to asecond of the pair of repositionable jaws; (c) a third link concurrentlyrepositionably and operatively coupled to the first of the pair ofrepositionable jaws and the second link; and, (d) a fourth linkconcurrently repositionably and operatively coupled to the second of thepair of repositionable jaws and the first link, where the third link isrepositionably and operatively coupled to the fourth link. In yetanother more detailed embodiment, the folding support includes a fifthlink concurrently repositionably and operatively coupled to a sixth linkand to the first link, wherein the sixth link is concurrentlyrepositionably and operatively coupled to the fifth link and to thesecond link. In a further detailed embodiment, the fifth and sixth linksare both mounted to and repositionable with respect to a pulley. Instill a further detailed embodiment, the second joint includes a firstcamming surface to facilitate repositioning of the fifth link, and thesecond joint includes a second camming surface to facilitaterepositioning of the sixth link. In a more detailed embodiment, a firstconnection is operatively coupled to the fifth and sixth links. In amore detailed embodiment, the first connection includes a pulleyoperatively coupled to the fifth and sixth links. In another moredetailed embodiment, the folding support comprises a folding pantographsupport.

It is a fourth aspect of the present invention to provide a method ofdeploying an occlusion clip comprising: (a) inserting an occlusion clipremovably mounted to an end effector deployment device havingrepositionable jaws through at least one of an incision and a trocar,the occlusion clip and the end effector deployment device mounted to oneanother when inserted into and through at least one of the incision andthe trocar; (b) repositioning the end effector deployment device toreposition the occlusion clip so the occlusion clip is interposed by aportion of a left atrial appendage interposing a base and a tip of theleft atrial appendage by passing the tip of the left atrial appendagebetween opposing clamping surfaces of the occlusion clip and; (c)clamping the left atrial appendage with the occlusion clip to occludethe left atrial appendage without piercing the left atrial appendagebetween the occlusion clip; (d) disengaging the occlusion clip from theend effector deployment device; and, (e) withdrawing the end effectordeployment device through at least one of the incision and the trocar.

In a more detailed embodiment of the fourth aspect, the inserting stepoccurs during at least one of an open sternotomy, a left thoracotomy, aright thoracotomy, a left port procedure, a right port procedure, asubxiphoid approach, and a transdiaphragmatic approach. In yet anothermore detailed embodiment, the method further includes insufflating athoracic space prior to the inserting step. In a further detailedembodiment, the method further includes making an incision as part of aprocedure comprising at least one of an open sternotomy, a leftthoracotomy, a right thoracotomy, a left port procedure, a right portprocedure, a subxiphoid approach, and a transdiaphragmatic approach, andintroducing a trocar through the incision. In still a further detailedembodiment, the end effector deployment device is mounted to alongitudinal conduit, which is mounted to a hand-held device, andrepositioning the end effector deployment device step includes actuatingat least one of a first control and a second control associated with thehand-held device to actively reposition the end effector within at leastone of an X-Y plane and a Y-Z plane with respect to the hand-helddevice. In a more detailed embodiment, the end effector deploymentdevice is mounted to a longitudinal conduit, which is mounted to ahand-held device, the method further comprising repositioning theocclusion clip from a compressed position to an expanded position priorto interposing a portion of the left atrial appendage between theopposing clamping surfaces. In a more detailed embodiment, the methodfurther includes actuating a handle associated with the hand-held deviceto direct repositioning of the occlusion clip between the compressedposition and the expanded position. In another more detailed embodiment,actuating the handle causes a pair of jaws associated with the endeffector to reposition with respect to one another, and the pair of jawsis mounted to the occlusion clip. In yet another more detailedembodiment, the end effector deployment device is mounted to alongitudinal conduit, which is mounted to a hand-held device, the methodfurther comprising rotationally repositioning the occlusion clip withrespect to the left atrial appendage by rotating the hand-held device.In still another more detailed embodiment, the method further includesgrasping the left atrial appendage concurrent with repositioning the endeffector deployment device to reposition the occlusion clip so the openend of the occlusion clip is interposed by the portion of the leftatrial appendage.

In yet another more detailed embodiment of the fourth aspect, the methodfurther includes repeating the repositioning and clamping steps prior tothe disengaging step. In yet another more detailed embodiment, themethod further includes confirming a clamping position of the occlusionclip is operative to occlude the left atrial appendage using at leastone of visualization and a transesophageal echocardiogram. In a furtherdetailed embodiment, the end effector deployment device is mounted to alongitudinal conduit, which is mounted to a hand-held device, anddisengaging the occlusion clip from the end effector deployment deviceincludes actuating a control associated with the hand-held device. Instill a further detailed embodiment, the control comprises arepositionable tab operatively coupled to a wire, which is operativelycoupled the end effector and the occlusion clip, and removing therepositionable tab from the hand-held device repositions the wire withrespect to at least one loop encompassing at least one of the occlusionclip and the end effector deployment device in order to disengage theocclusion clip from the end effector deployment device. In a moredetailed embodiment, the inserting step includes inserting the occlusionclip and the end effector deployment device through the trocar, thewithdrawing step includes withdrawing the end effector deployment devicethrough the trocar, and the trocar comprises a twelve millimeter or lessdiameter orifice. In a more detailed embodiment, the end effectordeployment device is mounted to a longitudinal conduit, which is mountedto a hand-held device, and the step of repositioning the end effectordeployment device to reposition the occlusion clip includes locking aposition of the end effect deployment device in at least one of an X-Yplane and a Y-Z plane with respect to the hand-held device.

It is a fifth aspect of the present invention to provide a method ofdeploying an occlusion clip comprising: (a) inserting an occlusion clipremovably mounted to an end effector deployment device havingrepositionable jaws through at least one of an incision and a trocar,the occlusion clip and the end effector deployment device mounted to oneanother when inserted into and through the trocar; (b) repositioning theend effector deployment device to reposition the occlusion clip so theocclusion clip is interposed by a portion of a left atrial appendageinterposing a base and a tip of the left atrial appendage by passing thetip of the left atrial appendage between opposing clamping surfaces ofthe occlusion clip; (c) clamping the left atrial appendage with theocclusion clip in an initial position without piercing the left atrialappendage between the occlusion clip; (d) assessing the operability ofthe occlusion clip in the initial position to occlude the left atrialappendage; and, (e) repositioning the end effector deployment device toreposition the occlusion clip to a subsequent position, different fromthe initial position, to clamp the left atrial appendage, whererepositioning the occlusion clip from the initial position to thesubsequent position is repeatable without affecting the structuralintegrity of the left atrial appendage.

It is an sixth aspect of the present invention to provide a method ofdeploying an occlusion clip comprising: (a) inserting an occlusion clipremovably mounted to an end effector deployment device, havingrepositionable jaws, through at least one of an incision and a trocar,the occlusion clip biased to a clamping position; (b) repositioning theend effector deployment device to counteract a bias of the occlusionclip and reposition the occlusion clip to a tissue insertion positionwhere the full bias of the occlusion clip is not applied to a leftatrial appendage tissue; (c) repositioning the end effector deploymentdevice to reposition the occlusion clip in the tissue insertion positionso a portion of a left atrial appendage between a base and a tip of theleft atrial appendage interposes the occlusion clip by having the tip ofthe left atrial appendage pass between opposing beams of the occlusionclip; (d) repositioning the occlusion clip to apply the full bias to theleft atrial appendage; and, (e) removing the end effector deploymentdevice from around the left atrial appendage without passing the tip ofthe left atrial appendage between the repositionable jaws.

In a more detailed embodiment of the sixth aspect, the method furtherincludes disengaging the occlusion clip from the end effector deploymentdevice, and withdrawing the end effector deployment device through atleast one of the incision and the trocar. In yet another more detailedembodiment, the inserting step occurs during at least one of an opensternotomy, a left thoracotomy, a right thoracotomy, a left portprocedure, a right port procedure, a subxiphoid approach, and atransdiaphragmatic approach. In a further detailed embodiment, themethod includes insufflating a thoracic space prior to the insertingstep. In still a further detailed embodiment, the method furtherincludes making an incision as part of a procedure comprising at leastone of an open sternotomy, a left thoracotomy, a right thoracotomy, aleft port procedure, a right port procedure, a subxiphoid approach, anda transdiaphragmatic approach, and introducing a trocar through theincision. In a more detailed embodiment, the end effector deploymentdevice is mounted to a longitudinal conduit, which is mounted to ahand-held device, and repositioning the end effector deployment devicestep includes actuating at least one of a first control and a secondcontrol associated with the hand-held device to actively reposition theend effector within at least one of an X-Y plane and a Y-Z plane withrespect to the hand-held device. In a more detailed embodiment, the endeffector deployment device is mounted to a longitudinal conduit, whichis mounted to a hand-held device, the method further comprisingrepositioning the occlusion clip from a compressed position to anexpanded position prior to interposing a portion of the left atrialappendage between the opposing clamping surfaces. In another moredetailed embodiment, the method further includes actuating a handleassociated with the hand-held device to direct repositioning of theocclusion clip between the compressed position and the expandedposition. In yet another more detailed embodiment, actuating the handlecauses a pair of jaws associated with the end effector to repositionwith respect to one another, and the pair of jaws is mounted to theocclusion clip. In still another more detailed embodiment, the endeffector deployment device is mounted to a longitudinal conduit, whichis mounted to a hand-held device, the method further comprisingrotationally repositioning the occlusion clip with respect to the leftatrial appendage by rotating the hand-held device.

In yet another more detailed embodiment of the sixth aspect, the methodfurther includes grasping the left atrial appendage concurrent withrepositioning the end effector deployment device to reposition theocclusion clip so the open end of the occlusion clip is interposed bythe portion of the left atrial appendage. In yet another more detailedembodiment, the method further includes confirming application of thefull bias of the occlusion clip is operative to occlude the left atrialappendage using at least one of visualization and a transesophagealechocardiogram. In a further detailed embodiment, the method furtherincludes disengaging the occlusion clip from the end effector deploymentdevice, where the end effector deployment device is mounted to alongitudinal conduit, which is mounted to a hand-held device, anddisengaging the occlusion clip from the end effector deployment deviceincludes actuating a control associated with the hand-held device. Instill a further detailed embodiment, the control comprises arepositionable tab operatively coupled to a wire, which is operativelycoupled to the end effector and the occlusion clip, and removing therepositionable tab from the hand-held device repositions the wire withrespect to at least one loop encompassing at least one of the occlusionclip and the end effector deployment device in order to disengage theocclusion clip from the end effector deployment device. In a moredetailed embodiment, the inserting step includes inserting the occlusionclip and the end effector deployment device through the trocar, and thetrocar comprises a twelve millimeter or less diameter orifice. In a moredetailed embodiment, the end effector deployment device is mounted to alongitudinal conduit, which is mounted to a hand-held device, and thestep of repositioning the end effector deployment device to repositionthe occlusion clip includes locking a position of the end effectdeployment device in at least one of an X-Y plane and a Y-Z plane withrespect to the hand-held device.

It is a seventh aspect of the present invention to provide a method offacilitating repositioning of an end effector and an occlusion clipmounted thereto, the method comprising: (a) providing an occlusion clipremovably mounted to an end effector; (b) providing a first attachmentoperatively coupled to the end effector and the occlusion clip, thefirst attachment operatively coupled to a first user control configuredto selectively disengage the end effector from the occlusion clip; (c)providing a first joint as part of the end effector to allowrepositioning of a first portion of the end effector with respect to asecond portion of the end effector, the first portion mounted to theocclusion clip, while the second portion is operatively coupled to theocclusion clip via the first portion.

In a more detailed embodiment of the seventh aspect, the firstattachment comprises loop and a wire, the loop at least partiallycircumscribing the occlusion clip and the wire when the occlusion clipis mounted to the end effector and no longer circumscribing the wirewhen the occlusion clip is removed from the end effector. In yet anothermore detailed embodiment, the method further includes providing a secondjoint as part of the end effector to allow repositioning of the secondportion of the end effector with respect to a third portion of the endeffector, the first joint allowing motion between the first portion andthe second portion in a first degree of freedom, the second jointallowing motion between the second portion and the third portion in asecond degree of freedom, different from the first degree of freedom. Ina further detailed embodiment, the method further includes providing asecond user control to direct repositioning of the first portion withrespect to the second portion, providing a third user control to directrepositioning of the second portion with respect to the third portion,where the second user control and the third user control comprise ahandheld control. In still a further detailed embodiment, the methodfurther includes providing a second user control to direct repositioningof the first portion with respect to the second portion, wherein thefirst user control and the second user control comprise a handheldcontrol. In a more detailed embodiment, the method further includesproviding a second joint as part of the end effector to allowrepositioning of the second portion of the end effector with respect toa third portion of the end effector, the first joint allowing motionbetween the first portion and the second portion in a first degree offreedom, the second joint allowing motion between the second portion andthe third portion in a second degree of freedom, different from thefirst degree of freedom.

In yet another more detailed embodiment of the seventh aspect, themethod further includes providing a third user control to directrepositioning of the second portion with respect to the third portion,wherein the third user control comprises a portion of the handheldcontrol. In yet another more detailed embodiment, the method furtherincludes providing parallel opening jaws that are removably mounted tothe occlusion clip and comprise a portion of the end effector. In afurther detailed embodiment, the parallel opening jaws comprise a firstjaw and a second jaw, the first jaw is pivotally mounted to a firstdrive link and a first parallel link, the second jaw is pivotallymounted to a second drive link and a second parallel link, and at leasttwo of the first drive link, the second drive link, the first parallellink, and the second parallel link are pivotally mounted to a pulley.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an elevated perspective view of an exemplary surgical tool inaccordance with the instant disclosure.

FIG. 2 is an elevated perspective view of the end effector of FIG. 1,shown in the expanded position after having deployed an occlusion clip.

FIG. 3 is an exploded view of the end effector of FIG. 2.

FIG. 4 is an elevated perspective view from a distal end of an exemplaryclevis in accordance with the instant disclosure.

FIG. 5 is an elevated perspective view from a proximal end of theexemplary clevis of FIG. 4.

FIG. 6 is a cross-sectional view of the exemplary clevis of FIG. 5 takenalong line 6-6.

FIG. 7 is a cross-sectional view of the exemplary clevis of FIG. 4 takenalong line 7-7.

FIG. 8 is an elevated perspective view from a distal end of an exemplaryuniversal in accordance with the instant disclosure.

FIG. 9 is a profile view of the exemplary universal of FIG. 8.

FIG. 10 is a cross-sectional view of the exemplary universal of FIG. 8taken along line 10-10.

FIG. 11 is a cross-sectional view of the exemplary clevis of FIG. 9taken along line 11-11.

FIG. 12 is an elevated perspective view from a distal end of anexemplary linkage housing in accordance with the instant disclosure.

FIG. 13 is a distal end view of the exemplary linkage housing of FIG.12.

FIG. 14 is a profile view of the exemplary linkage housing of FIG. 12.

FIG. 15 is a cross-sectional view of the exemplary linkage housing ofFIG. 14 taken along line 15-15.

FIG. 16 is an elevated perspective view from a proximal end of anexemplary drive link in accordance with the instant disclosure.

FIG. 17 is an elevated perspective view from a distal end of theexemplary drive link of FIG. 16.

FIG. 18 is a profile view of the exemplary drive link of FIG. 16.

FIG. 19 is an elevated perspective view from a distal end of a first jawin accordance with the instant invention.

FIG. 20 is profile view of a second jaw in accordance with the instantinvention.

FIG. 21 is an elevated perspective view from a proximal end of anexemplary parallel link in accordance with the instant disclosure.

FIG. 22 is an elevated perspective view from a side of the exemplaryparallel link of FIG. 21.

FIG. 23 is a bottom view of the exemplary parallel link of FIG. 21.

FIG. 24 is an elevated perspective view from a side showing theexemplary parallel links aligned with one another in a compact position.

FIG. 25 is an elevated perspective view from a distal end of anexemplary toggle in accordance with the instant disclosure.

FIG. 26 is an elevated perspective view from a bottom of the exemplarytoggle of FIG. 25.

FIG. 27 is a profile view of the exemplary toggle of FIG. 25.

FIG. 28 is an elevated perspective view showing assembly of the togglesand drive links.

FIG. 29 is an elevated perspective view showing assembly of the toggles,parallel links, and drive links.

FIG. 30 is a perspective view of the interior of a left side housing inaccordance with the instant disclosure.

FIG. 31 is a perspective view of the interior of a right side housing inaccordance with the instant disclosure.

FIG. 32 is a profile view of the interior of the right side housing ofFIG. 31 and components housed therein in accordance with the instantdisclosure.

FIG. 33 is an elevated perspective view of an exterior side of a firstwheel in accordance with the instant disclosure.

FIG. 34 is an elevated perspective view of an interior side of the firstwheel of FIG. 33.

FIG. 35 is an elevated perspective view from an exterior surface of afirst pulley and associated wires in accordance with the instantdisclosure.

FIG. 36 is an exploded view of the components of FIG. 35, less thewires.

FIG. 37 is an elevated perspective view from an interior surface of thefirst pulley of FIG. 35.

FIG. 38 is an elevated perspective view from an exterior surface of asecond pulley in accordance with the instant disclosure.

FIG. 39 is an elevated perspective view from an interior surface of asecond pulley and associated wires in accordance with the instantdisclosure.

FIG. 40 is an exploded view of the components of FIG. 39, less thewires.

FIG. 41 is an elevated perspective view of an exterior side of a secondwheel in accordance with the instant disclosure.

FIG. 42 is an elevated perspective view of an interior side of thesecond wheel of FIG. 41.

FIG. 43 is a profile view of an exemplary repositionable lock inaccordance with the instant disclosure.

FIG. 44 is an exploded view of the exemplary components of FIG. 43.

FIG. 45 is a cross-sectional view of the exemplary thumb button of FIG.43 taken along line 45-45.

FIG. 46 is an exploded view of an exemplary control for repositioningthe end effector jaws in accordance with the instant disclosure.

FIG. 47 is an assembled view of the exemplary control of FIG. 46.

FIG. 48 a cross-sectional view of the exemplary control of FIG. 47 takenalong line 47-47.

FIG. 49 is an elevated perspective view of an exemplary shaft assemblyalong with associated control and deployment wires in accordance withthe instant disclosure.

FIG. 50 is an end view taken from a distal end of an exemplaryrepositionable tab in accordance with the instant disclosure.

FIG. 51 is an end view taken from a distal end of another exemplaryrepositionable tab in accordance with the instant disclosure.

FIG. 52 is an elevated perspective view of an exemplary end effectorhaving mounted thereto an occlusion clip in a closed position.

FIG. 53 is an elevated perspective view of the exemplary end effectorand occlusion clip of FIG. 52 shown without repositionable jaws.

FIG. 54 is an elevated perspective view of the exemplary end effectorand occlusion clip of FIG. 52 shown without repositionable jaws, firstand second drive links, and first and second parallel links.

FIG. 55 is an elevated perspective view of the exemplary end effectorand occlusion clip of FIG. 52 shown without repositionable jaws, firstand second drive links, first and second parallel links, and first andsecond toggles.

FIG. 56 is an elevated perspective view of the exemplary end effectorand occlusion clip of FIG. 52 shown without repositionable jaws, firstand second drive links, first and second parallel links, first andsecond toggles, and linkage housing.

FIG. 57 is an elevated perspective view of the exemplary end effectorand occlusion clip of FIG. 52 shown without repositionable jaws, firstand second drive links, first and second parallel links, first andsecond toggles, linkage housing, and universal.

DETAILED DESCRIPTION

The exemplary embodiments of the present disclosure are described andillustrated below to encompass devices, methods, and techniques relatingto surgical procedures. Of course, it will be apparent to those ofordinary skill in the art that the embodiments discussed below areexemplary in nature and may be reconfigured without departing from thescope and spirit of the present disclosure. It is also to be understoodthat variations of the exemplary embodiments contemplated by one ofordinary skill in the art shall concurrently comprise part of theinstant disclosure. However, for clarity and precision, the exemplaryembodiments as discussed below may include optional steps, methods, andfeatures that one of ordinary skill should recognize as not being arequisite to fall within the scope of the present disclosure.

Referencing FIG. 1, an exemplary surgical tool 10 includes a usercontrol 20 mounted to a shaft assembly 30, which is mounted to anexemplary minimally invasive surgical end effector 100. The user control20 includes a first wheel control 40 to vary the yaw of the end effector100, while the user control 20 further includes a second wheel control50 to vary the pitch of the end effector. A user of the control 20 maymanipulate the roll of the end effector 100 simply by rolling the usercontrol. In order to selectively inhibit manipulation of the wheelcontrols 40, 50, a repositionable lock 60 is also provided. A proximalend of the user control 20 further includes a repositionable tab 70 thatmay be utilized to, in exemplary form, disengage a left atrial appendage(LAA) occlusion clip from the end effector 100. In addition, the usercontrol 20 includes a lever control 80 that is operative to controlrepositioning of the jaws of the end effector 100 with respect to oneanother. Several of the components of the lever control 80, the wheelcontrols 40, 50, and the repositionable lock 60 at least partiallyreside within a grip housing 90. A more detailed discussion of theexemplary components of the surgical tool 10 will be discussedsuccessively.

Referring to FIGS. 1-3 and 51-56, the exemplary end effector 100 may beused in minimally invasive surgical procedures to allow deployment of anLAA occlusion clip 102 with respect to a left atrial appendage (notshown). United States Patent Application Publication number2012/0059400, which describes an exemplary LAA occlusion clip 102, isincorporated herein by reference. As will be apparent to those skilledin the art after reviewing the instant disclosure, the end effector 100and surgical tool 10 may be utilized in capacities other than LAAocclusion clip deployment, each of which is within the scope of thisdisclosure.

The end effector 100 comprises a clevis 110 that is mounted proximallyto the shaft assembly 30 and distally to a proximal portion of auniversal 120, which is rotatably repositionable within an X-Y planewith respect to the clevis. A distal portion of the universal 120 ismounted to a proximal portion of a linkage housing 130 that is rotatablyrepositionable within a Y-Z plane with respect to the universal. Amedial portion of the linkage housing 130 has mounted to it a first pin160 that extends through a first drive link 140 and a second drive link150. In this fashion, the first drive link 140 and the second drive link150 are rotatably repositionable with respect to the linkage housing 130and with respect to one another along a common axis longitudinallyaligned with the first pin 160. A distal portion of the linkage housing130 has mounted to it a second pin 170 and a third pin 230 that extendsthrough proximal ends of a first parallel link 180 and a second parallellink 190. In this fashion, the first parallel link 180 and the secondparallel link 190 are rotatably repositionable with respect to thelinkage housing 130 and with respect to one another along a common axislongitudinally aligned with the second and third pins 170, 230.

Interposing the proximal ends of the first and second parallel links180, 190 are a first toggle 200, a second toggle 210, and a pulley 220.The pulley 220 includes a pair of cylindrical projections extending inopposite directions along a rotational axis of the pulley, where thefirst toggle 200 is mounted to a first of the cylindrical projectionsand the second toggle 210 is mounted to a second of the cylindricalprojections. A distal end of the first drive link 140 is mounted to aproximal end of a first jaw 240, whereas a distal end of the seconddrive link 150 is mounted to a proximal end of a second jaw 250. In thisfashion, the first drive link 140 is rotatably repositionable withrespect to the first jaw 240 along a common axis longitudinally alignedwith a fifth pin 260 that concurrently extends through the first drivelink and the first jaw. Similarly, the second drive link 150 isrotatably repositionable with respect to the second jaw 250 along acommon axis longitudinally aligned with a sixth pin 270 thatconcurrently extends through the second drive link and the second jaw.

Near the proximal end of the first jaw 240, inset distally from thelocation where the first drive link 140 is mounted, the distal end ofthe first parallel link 180 is mounted to the first jaw. In thisfashion, the first parallel link 180 is rotatably repositionable withrespect to the first jaw 240 along a common axis longitudinally alignedwith a seventh pin 290 that concurrently extends through the firstparallel link and the first jaw. In corresponding fashion, the proximalend of the second jaw 250, inset distally from the location where thesecond drive link 150, is mounted to the distal end of the secondparallel link 190. Similarly, the second parallel link 190 is rotatablyrepositionable with respect to the second jaw 250 along a common axislongitudinally aligned with an eighth pin 300 that concurrently extendsthrough the second parallel link and the second jaw.

In this exemplary end effector 100, the jaws 240, 250 are repositionedtoward and away from one another while maintaining a parallelorientation. In order to reposition the first and second jaws 240, 250with respect to one another, the first and second drive links 140, 150as well as the first and second parallel links 180, 190 are rotated withrespect to the linkage housing 130. To facilitate this repositioning ofthe jaws 240, 250 with respect to one another, the distal ends of thefirst and second toggles 200, 210 are mounted to medial portions ofrespective drive links 140, 150. In particular, the distal end of thefirst toggle 200 is mounted to a medial portion of the first drive link140 via a ninth pin 310. Accordingly, the first toggle 200 is rotatablyrepositionable with respect to the first drive link 140 along a commonaxis longitudinally aligned with the ninth pin 310. In addition, thedistal end of the second toggle 210 is mounted to a medial portion ofthe second drive link 150 via a tenth pin 320. Consequently, the secondtoggle 210 is rotatably repositionable with respect to the second drivelink 150 along a common axis longitudinally aligned with the tenth pin320. A more detailed discussion of the component parts of the endeffector 100 follows.

As shown in FIGS. 4-7, the clevis 110 includes an outer shell 400 thatdefines a longitudinal passage 402 extending therethrough. A proximalend 404 of the shell 400 includes an inner, cylindrical surface 406 thatcircumscribes an elongated shaft 1390 of the shaft assembly 30 (see FIG.53) and retains the shaft therein via a compression fit. This inner,cylindrical surface 406 abuts a dam 408 that inhibits further distalrepositioning of the shaft 1390. Extending through the dam 408 are apair of cylindrical through holes 410 interposed by an elongated throughhole 412. In exemplary form, separate control wires control wires 1272,1274 (see FIG. 56) extend through each cylindrical hole 410 and arecoupled to the universal 120 and to the first wheel control 40 so thatmanipulation of the first wheel control is operative to reposition theuniversal with respect to the clevis 110. In addition, another group ofwires 1172, 1174, 1364, 1402, 1404 (see FIG. 57) extend through theelongated hole 412. A more detailed discussion of the wires and thestructures to which each is mounted will be discussed hereafter.

On a distal side of the holes 410, 412, an overhang 416 andcorresponding underhang 418, along with corresponding interior walls422, partially define a distal opening. In particular, the overhang 416and underhang 418 are mirror images of one another and include anarcuate profile that curves away from the dam 408 until terminating atopposing planar upper and lower walls 424. Inset within each of theinterior walls 422 is a C-shaped depression 426, where the open end ofthe C-shape faces distally. As will be discussed in more detailhereafter, a peripheral surface 430 partially delineating the C-shapeddepression 426 bridges between the interior wall 422 and a step wall432, and provides a camming surface against which the universal 120rotates. In this exemplary embodiment, the interior walls 422 are planarand parallel to one another, as are the step walls 432, in addition tothe interior walls being parallel to the step walls. Interposing theupper and lower walls 424 are convex side surfaces 436, where the convexside surfaces abut distal curved surfaces 438 that partially delineatethe C-shaped depression 426 and likewise extend between the upper andlower walls. Extending proximally, the upper and lower walls 424 and theconvex side surfaces 436 transition from a generally rectangularexterior cross-section to a circular cross-section at a proximal end 440via a series of tapered walls 442. Extending distally from the clevis110 is the universal 120.

Referring to FIGS. 8-11, the universal 120 comprises a pair ofprojections 450 extending outward from opposing right and left sidesurfaces 452. In this exemplary embodiment, the projections 450 includea plateau surface 454 that is generally planar and parallel with theplanar surface of the nearest side surface 452. A peripheral shape ofeach projection 450 is rounded on a proximal end and comes to a point ona distal end 451 that is generally centered with a midline extendingthrough the universal 120. In particular, the peripheral surface 456 ofeach projection 450 is intended to contact and ride against theperipheral surface 430 of the clevis 110 (see FIG. 4) in order to allowpivotal motion between the clevis and universal 120. But the pointedshape of each projection 450, as embodied by two linear segments of theperipheral surface 456, is operative to provide opposing stops thatprevent complete rotation of the universal 120 with respect to theclevis 110. By way of example, the linear segments of the peripheralsurface 456 are angled approximately ninety degrees with respect to oneanother so that the universal 120 can rotate ±forty-five degrees withrespect to a longitudinal axis extending through the clevis 110 in theproximal-distal direction. Each projection 450 is generally centeredbetween opposing top and bottom surfaces 460 and distally inset from aproximal end 462.

The proximal end 462 of the universal 120 is semicircular in profile toride against the overhang 416 and underhang 418 of the clevis 110 (seeFIG. 4) when the universal is rotated with respect to the clevis. Inparticular, the proximal end 462 includes a central U-shaped channel 466that terminates at corresponding key-shaped through openings 468extending through the top and bottom surfaces 460 and into an interiorof the universal 120. The key-shaped opening 468 includes a cylindrical,enlarged opening 469 that is configured to accept an enlarged end of acontrol wire 1172, 1174 (see FIGS. 56 and 57). Once passing through thecylindrical opening 469, the enlarged end of the control wire 1172, 1174is retained within a capture, which is partially delineated via adepression 464, which inhibits throughput of the enlarged end of thecontrol wire through the smaller height aspect of the key-shaped throughopenings 468. A height of the U-shaped channel 466 extending along thetop and bottom surfaces is sufficient to accommodate the width of acontrol wire 1172, 1174, but not so high as to allow throughput of theenlarged end of the control wire, with the exception of through theenlarged cylindrical opening. Corresponding interior surfaces 470delineating a portion of the U-shaped channel 466 are convex and arcuatein shape. Extending co-planar with the U-shaped channel 466 is a throughopening 474 is sized to accommodate throughput of further control wires.The base of the U-shaped channel and the through opening 474 interposeopposing left and right side channels 476, 478.

A proximal end of each of the channels 476, 478 is delineated by spacedapart, arcuately shaped complementary walls 482,484. As mentionedpreviously, a peripheral surface of these walls 482, 484 ride againstthe overhang 416 and underhang 418 of the clevis 110. Each of thechannels 476, 478 tapers from proximal to distal and creates a dedicatedthrough opening that extends through the universal 120 and into aninternal region partially bounded by opposing distal extensions 490.

Inset within each interior wall 492 of the distal extensions 490 is aC-shaped depression 496, where the open end of the C-shape facesdistally. As will be discussed in more detail hereafter, a peripheralsurface 498 partially delineating the C-shaped depression 496 bridgesbetween the interior wall 492 and a step wall 502, and provides acamming surface against which the linkage housing 130 rotates. In thisexemplary embodiment, the interior walls 492 are planar and parallel toone another, as are the step walls 502, in addition to the interiorwalls being parallel to the step walls. The step walls 502 and the topand bottom surfaces 460 converge at respective distal ends of the distalextensions 490 to form a semicircular edge 504, which is interposed bythe linkage housing 130.

As shown in FIGS. 12-15, the linkage housing includes a pair ofprojections 510 extending outward from opposing top and bottom exteriorsurfaces 512. In this exemplary embodiment, the projections 510 includea plateau surface 514 that is generally planar and parallel with theplanar surface of the nearest top/bottom surface 512. A peripheral shapeof each projection 510 is rounded on a proximal end and comes to a pointon a distal end 511 that is generally centered with a midline extendingthrough the linkage housing 130. In particular, the peripheral surface516 of each projection 510 is intended to contact and ride against theperipheral surface 498 of the universal 120 in order to allow pivotalmotion between the linkage housing 130 and universal 120. But thepointed shape of each projection 510, as embodied by two linear segmentsof the peripheral surface 516, is operative to provide opposing stopsthat prevent complete rotation of the linkage housing 130 with respectto the universal 120. By way of example, the linear segments of theperipheral surface 516 are angled approximately ninety degrees withrespect to one another so that the linkage housing 130 can rotate±forty-five degrees with respect to a longitudinal axis extendingthrough the universal 120 in the proximal-distal direction. Eachprojection 510 is generally centered between opposing right and leftsides 520 and distally inset from a proximal end 522.

The proximal end 522 of the linkage housing 130 is semicircular inprofile. In particular, the proximal end 522 includes a miniatureU-shaped channel 526 that terminates at corresponding openings 528extending through the left and right side surfaces 520 and into aninterior of the linkage housing 130. Each opening 528 is configured toallow throughput of a separate control wire, but prohibit an enlargedend of that control wire 1272, 1274 from passing therethrough (see FIGS.14 and 57). And a height of the U-shaped channel 526 extending along theleft and right side surfaces 520 is sufficient to accommodate the widthof a control wire, but not so high as to allow throughput of theenlarged end of the control wire. In exemplary form, each control wireis inserted through one of the openings 528 (smaller diameter end first)so that the remainder of the control wire extends proximally and adistal, enlarged end of the control wire eventually interposesrespective outer retention arms 530, 532 and inner arms 534,536 when thewire is tensioned. Tensioning of both control wires 1272, 1274 isoperative to seat the enlarged end of each control wire within adepression 540 formed into the linkage housing 130.

Interposing the miniature U-shaped channel 526 and extending from thebase of the U-shaped channel is a central through channel 546 thatextends distally and terminates in between the inner arms 534, 536. Thecentral through channel 546 is sized to accommodate a control wire 1364coupled to the pulley 220 (see FIG. 55). As will be discussed in moredetail hereafter, repositioning of the pulley 220 with respect to thelinkage housing 130 results in component motion operative to increase ordecrease the distance between the opposing jaws 240, 250 responsive tocomponents being pivotally connected to the outer retention arms 530,532 and inner arms 534, 536.

In exemplary form, the outer retention arms 530, 532 each include aC-shaped depression 556, where the open end of the C-shape facesdistally, which is formed into a respective interior wall surface 552.As will be discussed in more detail hereafter, a peripheral surface 558partially delineating the C-shaped depression 556 bridges between theinterior wall surface 552 and a step wall surface 562, and provides acamming surface against which the parallel links 180, 190 rotate. Inthis exemplary embodiment, the interior wall surfaces 552 are planar andparallel to one another, as are the step wall surfaces 562, in additionto the interior wall surfaces being parallel to the step wall surfaces.The step wall surfaces 562 and the left and right side surfaces 520converge at respective distal ends of the outer retention arms 530, 532to form a semicircular edge 564. A distal orifice 568 extends throughthe step wall surface and through the entire outer retention arm 530,532. The distal orifice 568 is sized to accommodate one of the secondpin 170 and the third pin 230 in order to allow pivotal motion betweenthe linkage housing 130 and the parallel links 180, 190. By way ofexample, the distal orifices 568 of the outer retention arms 530, 532are cylindrical and have axial centers that lie along a common axis. Inaddition to the distal orifice, each outer retention arm 530, 532 alsoincludes a proximal orifice 570 that extends entirely through the outerretention arm. The proximal orifice 570 is sized to accommodate thefirst pin 160 in order to allow pivotal motion between the linkagehousing 130 and the drive links 140, 150. By way of example, theproximal orifices 570 of the outer retention arms 530, 532 arecylindrical and have axial centers that lie along a common axis.

The inner arms 534, 536 extend distally and are generally parallel withthe outer retention arms 530, 532, with spacing between each set ofadjacent arms. In exemplary form, the inner arms 534, 536 each include asingle hole 580 that extends laterally through the arm and iscylindrical in shape. A central axis extending through each hole 580 iscoaxial with the counterpart central axis of the other hole. Likewise,the central axis of the holes 580 is coaxial with the common axis of theproximal orifices 570 so that the holes and orifices are sized toaccommodate the first pin 160 in order to allow pivotal motion betweenthe linkage housing 130 and the drive links 140, 150 (see FIG. 2). Thespacing between the arms 534, 536 allows for proximal-to-distal motionof the pulley 220 therebetween, while prohibiting motion of the toggles200, 210 therebetween. Rather, the first arm 534 includes a triangularprojection extending distally, the hypotenuse of which comprises a firstsurface 582 that is angled to generally face the top surface 512.Similarly, the second arm 536 includes a triangular projection extendingdistally, the hypotenuse of which comprises a second surface 584 that isangled to generally face the bottom surface 512. In this exemplaryembodiment, the surfaces 582, 584 are perpendicular to one another and,as will be discussed in more detail hereafter, the toggles 200, 210contact these surfaces in order to limit repositioning of the toggles asthe pulley 220 is repositioned.

Referencing FIGS. 2 and 16-18, the first and second drive links 140, 150as well as the first and second parallel links 180, 190 are rotationallyrepositionable and mounted to the linkage housing 130. In exemplaryform, the first and second drive links 140, 150 are structurallyidentical, but differ only in operation based upon the componentsmounted thereto. Consequently, the following discussion of the structureof a drive link is applicable to both the first and second drive links140, 150.

Each drive link 140, 150 comprises a unitary structure including a pairof spaced apart, tilted uprights 590, 592 that are angled approximatelyforty-five degrees with respect to corresponding longitudinal extensions594, 596. The base of the uprights 590, 592 are joined to one anothervia a bridge 598. In exemplary form, each upright 590, 592 includes arounded proximal end 600 that interposes opposing planar surfaces 604,606. Extending completely through each upright 590, 592 is a hole 610partially bounded by the opposing planar surfaces 604, 606 and having acylindrical shape that is sized to accommodate throughput of the firstpin 160 and allow rotational repositioning of each upright around thefirst pin. Each upright 590, 592 also includes a step 612 recesseddistally beyond the proximal end 600 and the hole 610. The step 612, aswill be discussed in more detail hereafter, is inset to approximatelyhalf of the thickness of the widest portion of the upright 590, 592.Extending distally from the step 612, each upright 590, 592 seamlesslytransitions into a respective longitudinal extension 594, 596. Thebridge 598 is positioned approximate the transition region between theuprights 590, 592 and the longitudinal extensions 594, 596 and recessedwith respect to bottom planar surfaces 614 of the longitudinalextensions. On the top side 616 of each drive link 140, 150, the bridge598 seamlessly transitions into the longitudinal extensions 594, 596 anembodies an arcuate, convex longitudinal profile so that the top of eachlongitudinal extension includes a longitudinal ridge 618 extending fromthe bridge 598 distally toward a distal rounded end 620 of eachlongitudinal extension. Along the longitudinal length of eachlongitudinal extension 594, 596 is a pair of openings 622, 624 extendingcompletely through the longitudinal extensions between opposing lateralinner and exterior sides 628, 630. Each opening 622, 624 has acylindrical shape and is configured to receive at least one of thefifth, sixth, ninth, and tenth pins 260, 270, 310, 320. In this fashion,the first and second toggles 200, 210 as well as the first and secondjaws 240, 250 may be rotationally repositionable with respect to one ofthe drive links 140, 150.

Referring to FIGS. 2 and 25-27, the first and second toggles 200, 210 aswell as the first and second jaws 240, 250 are rotationallyrepositionable and mounted to the drive links 140, 150. In exemplaryform, the first and second toggles 200, 210 are structurally identical,but differ only in operation based upon the components mounted thereto.Consequently, the following discussion of the structure of a toggle isapplicable to both the first and second toggles 200, 210.

Each toggle 200, 210 comprises a unitary structure including toggleconnector portion 640 and a drive link connector portion 642. Inexemplary form, the toggle connector portion includes a rounded end 644with a substantially constant width that is approximately half of thewidth of the drive link connector portion 642. Along the longitudinallength of the toggle connector portion 640, an arcuate profile exists.This toggle connector portion 640 includes a through opening 646 havinga cylindrical shape and configured to receive a cylindrical projectionof the pulley 220 so that the toggle 200, 210 is rotationallyrepositionable about the pulley 220.

Opposite the toggle connector portion 640, the drive link connectorportion 642 includes an offset 648 extending widthwise beyond the widthof the toggle connector. An opening 650 extends through the drive linkconnector portion 642 and the offset 648 having a cylindrical shape andconfigured to receive one of the ninth and tenth pins 310, 320 so thatthe toggle 200, 210 is rotationally repositionable about a drive link140, 150. A partial circumferential groove 652 exists on the rounded end654 of the drive link connector portion 642. This groove 652 isconfigured to receive a portion of a deployment wire 1402, 1404 (seeFIG. 54) in order to allow the deployment wire to contact and beunimpeded by motion of the toggle 200, 210 when the toggle isrepositioned and/or when the deployment wire is repositioned withrespect to the jaws 240, 250 in order to detach, for example, a leftatrial occlusion clip 102 temporarily mounted to the jaws.

As shown in FIGS. 19 and 20, the jaws 240, 250 are structurally mirrorimages of one another. Consequently, the following discussion of thestructure of a jaw is generally applicable to both the first and secondjaws 240, 250.

Each jaw 240, 250 includes a rounded proximal end 660 that transitionsdistally into a rectangular cross-section with a pair of openings 662,664 extending between opposing top and bottom surfaces 666, 668 eachhaving a cylindrical shape and being configured to receive at least oneof the fifth, sixth, seventh, and eighth pins 260, 270, 290, 300 (seeFIG. 2). In this fashion, the first and second jaws 240, 250 may berotationally repositionable with respect to the drive links 140, 150 andthe parallel links 180, 190. The rectangular cross-section also includesone of a series of openings 670 on an interior surface 672 incommunication with a plurality of openings 674 and channels 676 formedinto the opposing exterior surface 678. In this exemplary embodiment,the channels 676 are sized and configured to receive a respectivedeployment wire 1402, 1404, whereas the openings 670, 674 are sized toaccommodate throughput of a suture retainer coupled to the left atrialocclusion clip 102. The interior surface 672 also has formed therein aLAA spring depression 676 sized and configured to receive a biasingspring of the left atrial occlusion clip 102 (see FIG. 52). This LAAspring depression 679 is in communication with a longitudinal depression677 formed into the interior surface 672 and the bottom surface 668. Andthis longitudinal depression 677 is sized and configured to receiveocclusion bars of the left atrial occlusion clip 102. Each jaw 240, 250tapers longitudinally from proximal to distal after passing beyond theLAA spring depression 679 to terminate at a rounded distal end 680. Aspart of repositioning the jaws 240, 250 with respect to one another, theparallel links 180, 190 are also repositioned with respect to oneanother.

Referring to FIGS. 2 and 21-24, the first and second parallel links 180,190 are structurally identical, but differ only in operation based uponthe components mounted thereto. Consequently, the following discussionof the structure of a parallel link is applicable to both the first andsecond parallel links 180, 190.

Each parallel link 180, 190 comprises a unitary structure including apair of spaced apart heads 700, 702 that are angled approximatelyforty-five degrees with respect to corresponding longitudinal legs 704,706. Near a base, the heads 700, 702 are joined to one another via alink 710. In exemplary form, each head 700, 702 includes a taperedproximal end 714, which is rounded at a far proximal tip, that includesa hole 716 partially bounded by opposing interior and exterior planarsurfaces 718, 720, as well as an arcuate exterior surface 722. The hole716 has a cylindrical shape that is size to accommodate throughput of atleast one of the seventh and eighth pin 290, 300 and allow rotationalrepositioning of a respective parallel link 180, 190 around a respectivejaw 240, 250. Each head 700, 702 includes an S-shaped profile 722 on onewidthwise side that is configured to track an inverse S-shaped profile724 associated with an opposite side of the same head 700, 702. In thisfashion, as shown in FIG. 24 when the parallel links 180, 190 arepositioned adjacent one another and the jaws 240, 250 are least spacedapart, the S-shaped contour 722 of one side of the first head 700 of thefirst parallel link 180 tracks the inverse S-shaped contour 724 of asecond side of the second head 702 of the second parallel link 190. Eachhead 700, 702 also includes a width that is roughly twice the width ofthe corresponding longitudinal legs 704, 706. In this fashion, theportion of heads 700, 702 with the inverse S-shaped profile 724 isoffset in a widthwise dimension from the corresponding longitudinal leg704, 706.

The corresponding longitudinal legs 704, 706 extend parallel and spacedapart from one another in the widthwise direction. The only meaningfuldifference between the corresponding longitudinal legs 704, 706 is thatthe first longitudinal leg 704 includes a widthwise offset 728 thatextends away from the second longitudinal leg 706 proximate the roundeddistal tip 730. Each longitudinal leg includes parallel, planar innerand outer surfaces 732, 734. A first hole 736 extends through the secondlongitudinal leg 706 proximate the distal tip 730, that is generallyequidistantly spaced from the distal tip 730 and corresponding upper andlower surfaces 740, 742. The first hole 736 has a cylindrical shape andis configured to receive at least one of the second and third pins 170,230 in order to allow the parallel links 180, 190 to rotate with respectto the linkage housing 130. A second hole 746 extends through the firstlongitudinal leg 704 and offset 728 proximate the distal tip 730, thatis generally equidistantly spaced from the distal tip 730 andcorresponding upper and lower surfaces 740, 742. The second hole 746 hasa cylindrical shape and is configured to receive at least one of thesecond and third pins 170, 230 in order to allow the parallel links 180,190 to rotate with respect to the linkage housing 130.

Referring to FIGS. 1-29 and 52-57, an exemplary assembly sequence forthe exemplary end effector 100 will now be described. Initially, thecontrol and deployment wires 1172, 1174, 1272, 1274, 1364, 1402, 1404are routed through the clevis 110. Specifically, the longitudinalpassage 402 at the proximal end 404 of the clevis receives the wires1172, 1174, 1272, 1274, 1364, 1402, 1404, which are then redirected sothat the control wires 1272, 1274 individually extend through arespective through hole 410 of the clevis, while the other wires 1172,1174, 1364, 1402, 1404 extend through the elongated through hole 412 ofthe clevis. After routing the wires through the clevis 110, theuniversal 120 is mounted to the clevis so that the projections 450 ofthe universal are received within respective C-shaped depressions 426.In order to retain the universal 120 in an engaged position with respectto the clevis, the control wires 1272, 1274 are individually fed throughone of the cylindrical, enlarged openings 469 of the universal 120 andknotted or otherwise processed to enlarge the ends of each control wiresitting within a respective depressions 464. The control wires 1272,1274 are then tensioned and mounted to the first wheel control 40 sothat rotation of the wheel control 40 will cause pivoting motion of theuniversal 120 with respect to the clevis 110. Likewise, the othercontrol wires 1172, 1174 are fed through a respective channel 476, 478of the universal 120, while the other wires 1364, 1402, 1404 extendthrough the opening 474 of the universal.

After routing the wires through the universal 120, the linkage housing130 is mounted to the universal so that the projections 510 of thelinkage housing are received within respective C-shaped depressions 496.In order to retain the linkage housing 130 in an engaged position withrespect to the universal 120, the control wires 1172, 1174 areindividually fed through one of the openings 528 of the linkage housingand knotted or otherwise processed to enlarge the ends of each controlwire sitting on the other side of the U-shaped channel 526. The controlwires 1172, 1174 are then tensioned and mounted to the second wheelcontrol 50 so that rotation of the wheel control 50 will cause pivotingmotion of the linkage housing 130 with respect to the universal 120.Conversely, the other wires 1364, 1402, 1404 extend through the channel546 of the linkage housing 130. At this point, the tilted uprights 590,592 of the drive links 140, 150 are offset and aligned with one anotherto fit between the linkage housing 130 proximate the orifices 570. Morespecifically the holes 610 of the tilted uprights 590, 592 arelongitudinally aligned with the holes 580 and the orifices 570 of thelinkage housing 130 in order to receive the first pin 160, which extendscompletely through the linkage housing and the drive links 140, 150.

The toggles 200, 210 are also mounted to a respective drive link 140,150, as well as concurrently to the pulley 220. Specifically, thethrough opening 650 of the first toggle 200 is oriented between andcoaxially aligned with the openings 622 extending through the firstdrive link 140. When aligned, the ninth pin 310 is inserted through theopenings 622, 650 to mount the first toggle 200 to the first drive link140. Similarly, the through opening 650 of the second toggle 210 isoriented between and coaxially aligned with the openings 622 extendingthrough the second drive link 150. When aligned, the tenth pin 320 isinserted through the openings 622, 650 to mount the second toggle 210 tothe second drive link 150. The opposing ends of the toggles 200, 210 aremounted to opposing ends of the pulley 220. More specifically, eachtoggle through opening 646 receives a respective cylindrical lateral endof the pulley 220 in order to rotationally mount the toggles 200, 210 tothe pulley. At this time, the pulley 220 is also mounted to the controlwire 1364 so that repositioning of the lever control 80 is operative toreposition the pulley and correspondingly other components in order tomove the jaws 240, 250 toward or away from one another in a parallelopen/close fashion.

Each jaw 240, 250 is then mounted to a respective drive link 140, 150,and parallel link 180, 190. In exemplary form, a first of the openings662 of a respective jaw 240, 250 is aligned with a respective opening624 of a respective drive link 140, 150. After being aligned, a fifthpin 260 and a respective sixth pin 270 are inserted through the openings624, 662 in order to pivotally mount a jaw 240, 250 to a respectivedrive link 140, 150. Similarly, a second of the openings 664 of arespective jaw 240, 250 is aligned with a respective hole 716 of arespective parallel link 180, 190. After being aligned, a seventh pin290 and a respective eighth pin 300 is inserted through the openings664, 716 in order to pivotally mount a jaw 240, 250 to a respectiveparallel link 180, 190. Also, the opposing ends of the parallel links180, 190 are offset and aligned with one another to fit between thelinkage housing 130 proximate the orifices 568. When aligned, second andthird pins 170, 230 are mounted to individual ends of the parallel links180, 190 and to the linkage housing 130 to provide for pivotal motionbetween the parallel links and the linkage housing. Before, during, orafter mounting the jaws 240, 250 to the drive links 140, 150 and theparallel links 180, 190, the deployment wires 1402, 1404 arerespectively directed through openings 674 of the jaws 240, 250 so thatthe user control 20 may be manipulated to deploy the LAA occlusion clip102.

Turning to FIGS. 1, 2, and 30-32, a more detailed discussion of the usercontrol 20, the first wheel control 40, the second wheel control 50, therepositionable lock 60, the repositionable tab 70, the lever control 80,and the grip housing 90 follows.

The grip housing 90 comprises respective left and right side housinghalves 1000, 1002. The left side housing 1000 includes a generallyconvex exterior surface 1004 and an opposite interior concave surface1006. The interior and exterior surfaces 1004, 1006 join one another ata peripheral surface 1008 that delineates the general outline of theleft side housing 1000. This left side peripheral surface 1008cooperates with a right side peripheral surface 1010 (which bridgesopposing interior and exterior surfaces 1012, 1014 of the right sidehousing 1002) to delineate five openings 1016-1024 that allow throughput of various components. It should be noted that the left side housingperipheral surface 1008 includes a lip that is correspondingly receivedwithin a recess of the right side housing peripheral surface 1010 tofacilitate alignment of the housings when mounted to one another. Morespecifically, the right side peripheral surface 1010 partially overlapsthe left side peripheral surface 1008 when the housings are mounted toone another as shown in FIG. 1.

By way of example, a first opening 1016 occurs at a distal end of thehousings 1000, 1002 and is sized and shaped in a circular fashion tocircumscribe and retain a proximal portion of the elongated cylindricalshaft 30. As will be discussed in greater detail hereafter, theelongated cylindrical shaft 30 includes longitudinal cut-outs 1392 thatreceive a pair of retention plates 1026 extending from the interiorsurface 1012 of the right side housing 1002.

The second opening 1018 occurs on an underside of the housing halves1000, 1002. This second opening 1018 is sized to accommodate a portionof the lever control 80. Inset from a distal end of the second openingis an integral, hollow axle 1028 extending from the interior surface1012 of the right side housing 1002. As will be discussed in more detailhereafter, a portion of the lever control 80 rotates about the axle 1028when the lever control is repositioned. In order to retain this portionof the lever control rotating about the axle 1028, the left side housing1000 includes a retention pin 1030 that is received by the hollow axle1028 and operates to mount adjacent portions of the housings 1000, 1002to one another. Inset from a proximal end of the second opening is anintegral spring retainer projection 1032 extending from the interiorsurface 1012 of the right side housing 1002. As will be discussed inmore detail hereafter, a spring of the lever control 80 is mounted tothe spring retainer projection 1032. In order to retain the springmounted to the spring retainer projection 1032, the left side housing1000 includes a retention cylinder 1034 that is hollow and sized toreceive the spring retainer projection 1032 and mount adjacent portionsof the housings 1000, 1002 to one another.

The third opening 1020 occurs at a proximal end 1036 of the housings1000, 1002 and is sized to receive a portion of the repositionable tab70. By way of example, the third opening 1020 is circular in nature andsized to retain a cylindrical portion of the repositionable tab 70 aspart of a friction fit that may be overcome by a user withdrawing thetab from a cylindrical portion from the grip housing 90. It should benoted, however, that other shapes besides circular openings may be usedas part of the third opening 1020. As shown in FIGS. 50 and 51, therepositionable tab 70 may embody any number of shapes including, withoutlimitation, an hourglass shape (see FIG. 50), a helical thread shape(see FIG. 51) and a triangular shape that requires rotation of therepositionable tab 70 with respect to the grip housing 90 in order toinsert and extract the repositionable tab from the grip housing.

Extending distally from the third opening 1020, the left side housing100 includes a linear projection 1038, extending proximal to distal,that is configured to guide motion of a portion of the lever control 80.Generally opposite this linear projection 1038, extending from theinterior surface 1012 of the right side housing 1002 is an oblong,hollow ridge 1040 that is sized to receive a portion of the levercontrol 80, yet allow this portion of the lever control to move thereinwithin a predetermined range of motion.

Above the second opening 1018 and extending proximally from the fourthopening 1022 of the right side housing 1002 interior surface 1012 is acontrol wire guide 1042 comprising three cylindrical projections spacedapart from one another vertically to allow a first gap between the firstand second projections and a second gap between the second and thirdprojections. As will be discussed in more detail hereafter, a controlwire coupled to the lever control 80 extends between the second andthird projections, while a pair of deployment wires coupled to therepositionable tab 70 extends between the first and second projections.In order to ensure the control wire and deployment wires stay in theaforementioned gaps, the left side housing 1000 includes ring 1044extending from the interior surface 1006 that circumscribes the controlwire guide 1042 to retain the wires within a respective gap.

The fourth opening 1022 occurs on a top side of the housings halves1000, 1002. This opening 1022 is sized to accommodate a portion of therepositionable lock 60. Positioned underneath the bounds of the fourthopening 1022 are complementary left and right ledges 1048, 1050 uponwhich the repositionable lock 60 sits. Each of the housing halves 1000,1002 also includes a triangular cavity 1054 that is configured toreceive a portion of the repositionable lock 60.

A fifth opening 1024 also occurs on a top side of the housing halves1000, 1002 and distal to the fourth opening 1022. This fifth opening1024 is sized to accommodate a portion of the first wheel control 40. Inparticular, a portion of the first wheel 1110 and the control knob 1160extend above the housings 1000, 1002 in order to allow a user tomanipulate the control knob and resultantly rotate the first wheel.

Adjacent the fifth opening is a sixth opening 1052 that extendscompletely though the top surface of the right side housing 1002.Interposing the fifth and sixth openings 1024, 1052 is an arcuatedivider comprised exclusively of the right side housing 1002. This sixthopening 1052 is sized to accommodate a portion of the second wheelcontrol 50. In particular, a portion of the second wheel 1140 and thecontrol knob 1260 extend above the housing 1002 in order to allow a userto manipulate the control knob and resultantly rotate the second wheel.

Extending outward from the interior surface 1006 of the left sidehousing 1000 is a pair of vertical guides 1056 that mirror a pair ofvertical guides 1058 extending from the interior surface 1012 of theright side housing 1002. The left side vertical guides 1056 are adaptedto contact the exterior track 1152 of the first wheel 1110 and allow thetrack to rotationally slide against the vertical guides. Similarly, theright side vertical guides 1058 are adapted to contact the exteriortrack 1252 of the second wheel 1140 and allow the track to rotationallyslide against the vertical guides. In this fashion, the vertical guides1056, 1058 act as lateral boundaries for the wheels 1110, 1140 as wellas the pulleys 1120, 1130. Interposing the vertical guides 1056, 1058are respective hollow cylinders 1060, 1062 extending from respectiveinterior surfaces 1006, 1012. Each hollow cylinder 1060, 1062 is sizedto receive a portion of an axle 1420 that extends through the wheels1110, 1140 and the pulleys 1120, 1130. Though not necessary, thedimensions of each hollow cylinder 1060, 1062 may be such that the axle1420 is retained therein via a friction fit and the axle is unable torotate with respect to the hollow cylinders, but still allow the wheelcontrols 40, 50 to be repositioned.

As discussed previously, the user control 20 includes a first wheelcontrol 40 to vary the yaw of the end effector 100, while the usercontrol 20 further includes a second wheel control 50 to vary the pitchof the end effector. In order to selectively inhibit manipulation of thewheel controls 40, 50, a repositionable lock 60 is also provided. Aproximal end of the user control 20 further includes a repositionabletab 70 that may be utilized to, in exemplary form, disengage a leftatrial appendage (LAA) occlusion clip 102 from the end effector 100. Inaddition, the user control 20 includes a lever control 80 that isoperative to control repositioning of the jaws 240, 250 of the endeffector 100 with respect to one another. Several of the components ofthe lever control 80, the wheel controls 40, 50, and the repositionablelock 60 at least partially reside within a grip housing 90.

As shown in FIGS. 32-42, the first and second wheel controls 40, 50rotate about an axle 1420 received within corresponding cylindricalcavities 1024, 1056 formed within the right and left side housing halves1000, 1002. The axle 1420 is cylindrical in shape and extends throughthe center of a first wheel 1110, a first pulley 1120, a second pulley1130, and a second wheel 1140. The first wheel 1110 and the first pulley1120 are components of the first wheel control 40, whereas the secondwheel 1140 and the second pulley 1130 are components of the second wheelcontrol 50.

In exemplary form, referring to FIGS. 33 and 34, the first wheel 1110comprises a unitary structure having a generally circular shape andincluding a central opening 1150 accommodating throughput of the axle1420. Radially outward from this opening 1150 and partiallycircumscribing the opening is a track 1152 extending outward from anexterior, side surface 1154. Adjacent this exterior, side surface 1154is a peripheral surface 1156, with an arcuate transition surface 1158interposing the side and circumferential surfaces. Extending radiallyoutward from the peripheral surface 1156 is a control knob 1160 withindicia 1162 on the top of the control knob providing a user with anindication that rotation of the first wheel 1110 is operative toreposition the end effector 100 laterally within an X-Y plane. In orderto transfer rotation of the first wheel 1110 into lateral motion of theend effector, the first wheel also includes a pair of protrusions 1166on opposing radial sides of the opening 1150. As will be discussed inmore detail hereafter, these protrusions 1166 are received withincorresponding pockets of the first pulley 1120 so that rotational motionof the first wheel 1110 is transferred into rotational motion of thefirst pulley. Radially outset from the opening 1150 and one of theprotrusions 1166 are a plurality of teeth 1170 circumferentially insetand distributed about ninety degrees of the circumference.

Referring to FIGS. 35-37, a second component of the first wheel control40, the first pulley 1120, is operative to convert rotational motion ofthe first wheel 1110 into longitudinal motion of at least one of a firstpair of control wires 1172, 1174. The control wires 1172, 1174 aremounted to the first pulley 1120 using a clamp plate 1176 and a setscrew 1178. In exemplary form, the first pulley 1120 includes a firstthrough opening 1180 sized and configured to receive throughput of theaxle 1420 so that the first pulley may rotate about the axle, inaddition to a second through opening 1182 sized and configured toreceive an upstanding cylinder 1186 of the clamp plate 1176. But thesecond through opening 1182 is too small to allow throughput of abacking plate 1188 of the clamp plate 1176. Accordingly, a rear of thefirst pulley 1120 includes a recess 1190 sized and configured to receivethe backing plate 1188 and inhibit rotation of the backing plate withrespect to the first pulley 1120. The rear of the first pulley 1120 alsoincludes a semi-circular spacer 1191 partially delineating the firstthrough opening and extending laterally away from a center of the firstpulley. The spacer 1191 is operative to provide a gap between the firstand second pulleys 1120, 1130.

The upstanding cylinder 1186 includes an axial through opening 1192 thatis threaded to engage the threads of the set screw 1178, as well as fourradial openings 1194 that are sized and configured to receive at leastone of the control wires 1172, 1174. By way of example, the four radialopenings 1194 are circular and radially distributed to be equidistantlyspaced from one another about the circumference of the upstandingcylinder 1186. A first and second of the radial openings 1194 arelocated proximate first and second openings 1198 extending through awall 1200 extending laterally outward and adjacent the second throughopening 1182.

In exemplary form, the first control wire 1172 is routed over a firstarcuate surface 1202 that extends laterally outward from the firstpulley 1120 so that the free end of the first control wire interposesbetween a radial wall 1204 and a first guide 1206. The free end of thefirst control wire 1172 is then directed through a bottom opening(second opening) 1198 and directed through the nearest radial opening1194. After passing beyond the nearest radial opening, the free end ofthe first control wire 1172 is passed through the radial openingopposite (180 degrees opposed) from the radial opening the first controlwire already extends through. Similarly, the second control wire 1174 isrouted over a second arcuate surface 1212 that extends laterally outwardfrom the first pulley 1120 so that the free end of the second controlwire interposes between the radial wall 1204 and a second guide 1216.The free end of the second control wire 1174 is then directed through atop opening (first opening) 1198 and directed through the nearest radialopening 1194. After passing beyond the nearest radial opening, the freeend of the second control wire 1174 is passed through the radial openingopposite (180 degrees opposed) from the radial opening that the firstcontrol wire already extends through. After both control wires 1172,1174 have passed through the radial openings 1194, the set screw 1178 isthreaded into the axial through opening 1192 to crimp the control wiresin place. This crimping operation is undertaken while both control wires1172, 1174 are put into a predetermined amount of tension and the endeffector 100 is in a neutral position within the X-Y and Y-Z planes.

Turning to FIGS. 38-42, the second wheel 1140 of the second wheelcontrol 50 comprises a unitary structure having a generally circularshape and including a central opening 1250 accommodating throughput ofthe axle 1420. Radially outward from this opening 1250 and partiallycircumscribing the opening is a track 1252 extending outward from anexterior, side surface 1254. Adjacent this exterior, side surface 1254is a peripheral surface 1256, with an arcuate transition surface 1258interposing the side and circumferential surfaces. Extending radiallyoutward from the peripheral surface 1256 is a control knob 1260 withindicia 1262 on the top of the control knob providing a user with anindication that rotation of the second wheel 1140 is operative toreposition the end effector 100 vertically within a Y-Z plane. In orderto transfer rotation of the second wheel 1140 into vertical motion ofthe end effector 100, on an opposite side of the second wheel is acylindrical projection 1266 with three spokes equidistantly spaced fromone another and radially extending around the opening 1250. As will bediscussed in more detail hereafter, the cylindrical projection 1266 andspokes are received within corresponding pockets of the second pulley1130 so that rotational motion of the second wheel 1140 is transferredinto rotational motion of the second pulley. Radially outset from theopening 1250 and the cylindrical projection 1266 are a plurality ofteeth 1270 circumferentially inset and distributed about ninety degreesof the circumference.

A second component of the second wheel control 50, the second pulley1130, is operative to convert rotational motion of the second wheel 1140into longitudinal motion of at least one of a first pair of controlwires 1272, 1274. The control wires 1272, 1274 are mounted to the secondpulley 1130 using a clamp plate 1276 and a set screw 1278. In exemplaryform, the second pulley 1130 includes a first through opening 1280 sizedand configured to receive throughput of the axle 1420 so that the secondpulley may rotate about the axle, in addition to a second throughopening 1282 sized and configured to receive an upstanding cylinder 1286of the clamp plate 1276. But the second through opening 1282 is toosmall to allow throughput of a backing plate 1288 of the clamp plate1276. Accordingly, a front of the second pulley 1130 includes a recess1290 sized and configured to receive the backing plate 1288 and inhibitrotation of the backing plate with respect to the second pulley 1130.The front of the second pulley 1130 also includes a depression 1291 thatis sized to receive the cylindrical projection 1266 and the spokes ofthe second wheel 1140.

The upstanding cylinder 1286 of the clamp plate 1276 includes an axialthrough opening 1292 that is threaded to engage the threads of the setscrew 1278, as well as four radial openings 1294 that are sized andconfigured to receive at least one of the control wires 1272, 1274. Byway of example, the four radial openings 1294 are circular and radiallydistributed to be equidistantly spaced from one another about thecircumference of the upstanding cylinder 1286. A first and second of theradial openings 1294 are located proximate first and second openings1298 extending through a wall 1300 extending laterally outward andadjacent the second through opening 1282.

In exemplary form, the first control wire 1272 is routed over a firstarcuate surface 1302 that extends laterally outward from the secondpulley 1140 so that the free end of the first control wire interposesbetween a radial wall 1304 and a first guide 1306. The free end of thefirst control wire 1272 is then directed through a bottom opening(second opening) 1298 and directed through the nearest radial opening1294. After passing beyond the nearest radial opening, the free end ofthe first control wire 1272 is passed through the radial openingopposite (180 degrees opposed) from the radial opening that the firstcontrol wire already extends through. Similarly, the second control wire1274 is routed over a second arcuate surface 1312 that extends laterallyoutward from the second pulley 1140 so that the free end of the secondcontrol wire interposes between the radial wall 1304 and a second guide1316. The free end of the second control wire 1274 is then directedthrough a top opening (first opening) 1298 and directed through thenearest radial opening 1294. After passing beyond the nearest radialopening, the free end of the second control wire 1274 is passed throughthe radial opening opposite (180 degrees opposed) from the radialopening the first control wire already extends through. After bothcontrol wires 1272, 1274 have passed through the radial openings 1294,the set screw 1278 is threaded into the axial through opening 1292 tocrimp the control wires in place. This crimping operation is undertakenwhile both control wires 1272, 1274 are put into a predetermined amountof tension and the end effector 100 is in a neutral position within theY-Z plane. After crimping, rotation of the wheels 1110, 1140 isoperative to change the lateral and vertical position of the endeffector 100. And these positions when achieved by user manipulation toa predetermined location may be retained using the repositionable lock60.

Turning to FIGS. 43-45, the repositionable lock 60 includes a thumbbutton 1320 that is spring biased with respect to a base plate 1322. Inexemplary form, the thumb button 1320 includes a hollow cavity 1334 openon an underneath side of the thumb button that is sized to receive aportion of a spring 1324 and a pylon 1326. Assembly of therepositionable lock 60 includes feeding a tapered end 1328 of the pylon1326 through an opening 1330 extending through the base plate 1322 sothat a flange 1332 at an opposing end of the pylon inhibits completethroughput of the pylon. After having the pylon 1326 extend through thebase plate 1322, the spring 1324 is positioned to circumscribe themajority of the longitudinal length of the pylon. Thereafter, thetapered end 1328 of the pylon 1326, along with a portion of the spring1324, is inserted into the hollow cavity 1334 open on an underneath sideof thumb button 1320.

When the repositionable lock 60 is mounted to the housings 1000, 1002, abottom of the base plate 1322 is seated upon the complementary left andright ledges 1048, 1050. In order to maintain the repositionable lock 60in a biased state, the fourth opening 1022 lateral or widthwisedimension is smaller than the lateral or widthwise dimension of a base1336 of the thumb button 1320, thereby precluding vertical removal ofthe thumb button (and repositionable lock 60 internal components) fromthe interior of the housings 1000, 1002 when the housings are mounted toone another. In other words, the housings 1000, 1002 ledges 1048, 1050and peripheral surfaces 1008, 1010 operate to sandwich therepositionable lock 60 components therebetween (but for a thump pad 1340of the thumb button 1320). A portion of each housing 1000, 1002delineating the fourth opening 1022 operates as overhangs so that thetriangular cavity 1054 of each housing is longitudinally aligned withcorresponding triangular projections 1338 of the thumb button 1320. Inthis fashion, the repositionable lock 60 is longitudinallyrepositionable (in a proximal-distal direction) with respect to thehousings 1000, 1002 within a predetermined range of motion. At aproximal end of the range of motion, the triangular projections 1338 ofthe thumb button 1320 are received within the triangular cavities 1054of the housings 1000, 1002. When in this position, the repositionablelock 60 is beyond an area of travel of the first and second wheelcontrols 40, 50. But when the thump pad 1340 of the thumb button 1320 isdepressed and moved distally, causing the thumb button to slide on topof the ledges 1048, 1050 and underneath the peripheral surfaces 1008,1010, the triangular projections 1338 are removed from the triangularcavities 1054 of the housings 1000, 1002. Upon reaching the distal endof the range of motion for the repositionable lock 60, a distal taperedend 1342 of the base plate 1322 interposes two adjacent teeth of eachplurality of teeth 1170, 1270, thereby inhibiting rotational motion ofboth wheels 1110, 1140 and rotational motion of both pulleys 1120, 1130.In this distal position, the repositionable lock 60 is operative to lockthe vertical position and the lateral position of the end effector 100.It is envisioned that while in this locked position, the end effector100 may manipulated using the lever control 80 to reposition the jaws240, 250 of the end effector 100 to open the occlusion clip 102.

Referring to FIGS. 46-48, the lever control 80 comprises a handle 1350pivotally mounted to the hollow axle 1028 extending from the interiorsurface 1012 of the right side housing 1002. A trigger 1352 isconcurrently and pivotally mounted to the hollow axle 1028 andinterposes spaced apart loops 1354 of the handle 1350. The trigger 1352is repositionable with respect to the handle 1350 in order to lock andselectively unlock a position of the handle with respect to a slide arm1356. In exemplary form, the slide arm 1356 is pivotally mounted to thehandle 1350 using a pin 1358 and is concurrently mounted to a bobbin1360 that is configured to slide within the oblong, hollow ridge 1040 ofthe right side housing 1002 in proximal and distal directions. A spring1362, mounted to the slide arm 1356 and to the spring retainerprojection 1032 of the right side housing 1002, operates to bias theslide arm 1356 in its most distal position. But this spring bias may beovercome by a user pulling upward on the handle 1350 (toward the secondopening 1018), thereby causing the handle to pivot and reposition theslide arm 1356 proximally. As the slide arm 1356 is repositioned, so toois the bobbin 1360 and a control wire 1364 mounted to the bobbin. Morespecifically, as the bobbin 1360 is repositioned proximally from thehandle 1350 being pulled toward the housings 1000, 1002, the controlwire 1364 is repositioned proximally as a result of being placed undergreater tension. Upon the bobbin 1360 reaching near or at the mostproximal of its range of motion, the trigger 1352 engages the slide arm1356 to inhibit further motion that would result in the bobbin movingdistally. In this fashion, the trigger 1352 operates to lock theposition of the slide arm 1356 and the bobbin 1360, which in exemplaryform corresponds to the end effector 100 opening the occlusion clip 102for positioning about a left atrial appendage.

The handle 1350 has a generally arcuate shape, with a concave rearprofile and a convex front profile. On this front profile are a seriesof raised juts 1366 that more readily allow a user to grip the handle1350. The rear profile is majorly delineated by a pair of spaced apartstruts 1368 that are interposed by a series of ribs 1370 that cooperateto form a series of hollows. Each strut 1368 includes a through orificealigned with the other strut and sized to receive the pin 1358 aboutwhich the slide arm 1356 rotates. And each strut 1368 terminates at aspaced apart loop 1354 that facilitates mounting the handle 1350 to thehousings 1000, 1002, while concurrently unimpeding rotation of the slidearm 1356.

In exemplary form, the slide arm 1356 includes a head 1372 with anorifice that receives the pin 1358, where the head is connected to abody 1374 of the slide arm via neck 1376. Proximate where the head 1372and neck 1376 join one another on the top side of the slide arm 1356 isa V-shaped cavity 1380, which is accompanied by a catch 1382 formed intothe head. As will be discussed in more detail hereafter, the V-shapedcavity 1380 is intended to receive a portion of a rider 1384 of thetrigger 1352 as the handle is in an extended position. But as the handle1350 is rotated upward, the rider 1384 slides against the top surface ofthe slide arm 1356 and out of the V-shaped cavity 1380 and becomesseated within the catch cavity 1382 when the handle is fully or almostfully brought adjacent the housings 1000, 1002 (indicative of the slidearm 1356 being positioned proximally to tension the control wire 1364and, in exemplary form, operative to move the jaws 240, 250 apart fromone another to open the occlusion clip 102). In order to release thehandle from this rotated position adjacent the housings 1000, 1002, aforward end 1386 of the trigger 1352 is depressed, thereby causing therider 1384 to move out of the catch cavity 1380 and into the V-shapedcavity 1380. When this occurs (in addition to slacking the control wire1364 and move the jaws 240, 250 toward one another), presuming the useris not pulling upward on the handle 1350, the spring bias resulting fromthe spring 1362 being in tension causes the slide arm 1356 to movedistally and pivot about the handle 1350, thereby moving the handle awayfrom the housings 1000, 1002. A more detailed discussion of the controland deployment wires and the shaft assembly 30 follows.

Referring to FIGS. 1, 49, and 51-56, the shaft assembly 30 couples theend effector 100 to the user control 20. In exemplary form, the shaftassembly includes an elongated shaft 1390 having a pair of longitudinalcut-outs 1392 sized to receive the pair of retention plates 1026extending from the interior surface 1012 of the right side housing 1002.The retention plates 1026 mount the shaft assembly 30 to the usercontrol 20 and also operate to inhibit proximal-distal repositioning ofthe shaft assembly independent of the user control. The elongated shaft1390 is cylindrical in shape and extends in a generally lineardirection. An interior of the elongated shaft 1390 is hollow andincludes opposing proximal and distal circular openings 1394 at eachend. The proximal opening 1394 is sized to allow insertion of a wirealignment guide 1398 (which also has corresponding cut-outs to receivethe retention plates 1026) having three dedicated through channels 1406,1408, and 1410. Each through channel is configured to receive at leasttwo wires and operates to inhibit tangling of adjacent wires. Morespecifically, the first channel 1406 receives the control wires 1172,1174 mounted to the first pulley 1120. A second channel 1408 receivesthe deployment wires 1402, 1404 mounted to the repositionable tab 70, aswell as receiving control wire 1364 mounted to the bobbin 1360. Finally,the third channel 1410 receives the control wires 1272, 1274 mounted tothe second pulley 1130. The wire alignment guide 1398 need not extendthe entire length of the elongated shaft 1390 so that the distal endopening provides for throughput of all of the wires 1172, 1174, 1272,1274, 1364, 1402, 1404 where the wires are segregated using the clevis110, which circumscribes and mounts to the elongated shaft via frictionfit. More specifically, the longitudinal passage 402 at the proximal end404 of the clevis is sized to receive the distal end of the elongatedshaft 1390. In this manner, the control wires 1272, 1274 individuallyextend through a respective through hole 410 of the clevis, while theother wires 1172, 1174, 1364, 1402, 1404 extend through the elongatedthrough hole 412 of the clevis. Downstream from the clevis 110, thecontrol wires 1272, 1274 are individually fed through one of thecylindrical, enlarged openings 469 of the universal 120 andcorrespondingly mounted to the universal. Likewise, the control wires1172, 1174 individually extend through a respective channel 476, 478 ofthe universal 120, while the other wires 1364, 1402, 1404 extend throughthe opening 474 of the universal. Downstream from the universal 120, thecontrol wires 1172, 1174 are individually fed through one of theopenings 528 of the linkage housing and correspondingly mounted to thelinkage housing. Conversely, the other wires 1364, 1402, 1404 extendthrough the channel 546 of the linkage housing 130. Downstream from thelinkage housing 130, the control wire 1364 is mounted to the pulley 220,while the deployment wires 1402, 1404 are respectively directed throughopenings 674 of the jaws 240, 250.

Turning back to FIGS. 30-57, assembly of the exemplary user control 20will be described in more detail. In exemplary form, the wires 1172,1174, 1272, 1274, 1364, 1402, 1404 are routed through the elongatedshaft 1390 and the wire alignment guide 1398 and into the interior ofthe housings 1000, 1002. In particular, the deployment wires 1402, 1404are routed to the proximal end of the user control 20 and attached tothe repositionable tab 70. In exemplary fashion, the repositionable tab70 may be frictionally seated within the proximal opening 1020 or may beotherwise attached so that removal of the repositionable tab requiresrotational motion. In addition to the deployment wires 1402, 1404 beingrouted, so too is the deployment wire 1364. By way of example, thetrigger 1352 and the handle 1350 are aligned so that the hollow axle1028 of the right side housing 1002 extends through both components.Likewise, the slide arm 1356 is pivotally mounted to the handle 1350 viathe pin 1358. An opposing portion of the slide arm 1356 is mounted tothe bobbin 1360 so that a portion of the bobbin is seated within acavity within the right side housing 1002 delineated by the hollow ridge1040. The deployment wire 1364 is mounted to the bobbin 1360, while theslide arm 1356 and bobbin are spring biased by way of engagement betweenthe spring 1362, which is also mounted to the right side housing 1002.In this fashion, the lever control 80 is spring biased and operative toopen and close the jaws 240, 250.

Four of the control wires 1172, 1174, 1272, 1274 are associated with thefirst and second wheel controls 40, 50. Specifically, assembly of thewheel controls 40, 50 includes positioning the second wheel 1140 toextend through the sixth opening 1052 extending through the right sidehousing. The axle 1420 is positioned to extend through the center of thesecond wheel 1140 and be received within the hollow cylinder 1062 of thehousings 1000, 1002. Before assembling the housings 1000, 1002, however,the axle 1420 receives in succession the second pulley 1130, the firstpulley 1120, and the first wheel 1110. After the pulleys 1120, 1130 arereceived on the axle 1420, the control wires 1172, 1174, 1272, 1274 aremounted thereto while ensuring the end effector 100 is in a yaw andpitch neutral position. As discussed previously, two control wires 1172,1272 go over top of a respective pulley 1120, 1130, while the other twocontrol wires 1174, 1274 go under a respective pulley and are securedthereto via a clamp plate 1176, 1276 and a set screw 1178, 1278. In thisfashion, when a user decides to change the yaw of the end effector 100,the user engages the control knob 1160 of the first wheel 1110 to rotatethe first wheel clockwise or counterclockwise. In exemplary fashion,clockwise rotation of the first wheel 1110 (moving the control knobproximally) operates to pivot the universal 120 with respect to theclevis 110 to the right, whereas counterclockwise rotation of the firstwheel (moving the control knob distally) operates to pivot the universalwith respect to the clevis to the left. Moreover, when a user decides tochange the pitch of the end effector 100, the user engages the controlknob 1260 of the second wheel 1140 to rotate the second wheel clockwiseor counterclockwise. In exemplary fashion, clockwise rotation of thesecond wheel 1140 (moving the control knob proximally) operates to pivotthe linkage housing 130 upward with respect to the universal 120,whereas counterclockwise rotation of the second wheel (moving thecontrol knob distally) operates to pivot the linkage housing 130downward with respect to the universal 120.

In order to retard unwanted rotation of the first and second wheel 1110,1140, installation of the repositionable lock 60 includes seating thebase plate 1336 upon the corresponding ledges 1048, 1050 (initially uponthe right side ledge 1048) after already having assembled therepositionable lock as discussed above. When installed properly, onlythe thumb pad 1340 of the thumb button 1320 extends above the housings1000, 1002. And proximal and distal motion of the repositionable lock 60are available, where a most distal position of the repositionable lockplaces the base plate 1342 to interpose corresponding teeth 1170, 1270of the wheels 1110, 1140, thereby inhibiting further rotation of thewheels. The repositionable lock 60 may be disengaged simply by movingthe thumb pad 1340 proximally until the base plate 1342 no longerengages corresponding teeth 1170, 1270 of the wheels 1110, 1140.

After the associated components have been installed and mounted to theright side housing 1002, the left side housing 100 may be repositionedto close the interior and contain the desired portions of thecomponents. In order to ensure continued closure of the housings 1000,1002, it is within the scope of the invention to weld or otherwisefasten the peripheral surfaces of the housings using any number ofoptions such as, without limitation, press fit, screws/fastenersadhesives, ultrasonic welding, heat welding, and laser welding.

The following comprises a description of exemplary processes forutilizing the exemplary surgical tool 10. Initially, an incision is madeon either the left or right side of the chest wall in an intercostalspace that is appropriate for the desired angle of approach to a leftatrial appendage (LAA). The incision may be made through the chest wallor through the abdomen (or through the back) as part of variousprocedures that include, without limitation, an open sternotomy, a leftthoracotomy, a right thoracotomy, a left port, a right port, asubxiphoid approach, and a transdiaphragmatic approach. Post incision, atrocar (e.g., 10 mm or larger) may be inserted through the incision toextend into the thoracic cavity. In certain instances, it may bepreferred to insufflate the thoracic space subsequent to trocarinsertion using known techniques. Using at least one of the incision andtrocar, surgical instruments are introduced into the thoracic space inorder to perform a series of dissections, including dissection of thepericardium, to provide egress to the LAA. After having access to theLAA, the end effector 100 of the surgical tool 10 may be inserted intothe thoracic cavity by way of the incision or trocar.

The end effector 100 is passed through the trocar or incision and theuser manipulates the user controls 20 to navigate the end effectorproximate the LAA. By way of example, the first wheel control 40 isoperative to vary the yaw of the end effector 100 within an X-Y plane(e.g., depending upon the frame of reference, the first wheel control 40provide lateral adjustability of the end effector 100 with respect tothe housings 1000, 1002), as well as the second wheel control 50 beingoperative to vary the pitch of the end effector within an Y-Z plane(e.g., depending upon the frame of reference, the second wheel control50 provides up and down adjustability of the end effector with respectto the housings). Specifically, a user grasping the user control 20 isable to rotate the first wheel 1110 to change the lateral position ofthe end effector 100, to which the LAA occlusion clip 102 is mounted, bytensioning a control wire 1172, 1174 extending though the clevis 110 andmounted to the universal 120. Likewise, the user grasping the usercontrol 20 is able to rotate the second wheel 1140 to change thevertical position of the end effector 100 by tensioning a control wire1272, 1274 extending though the clevis 110 and universal 120 that ismounted to the linkage housing 130. If desired, the user of the surgicaltool 10 may use the thumb button 1320 of the repositionable lock 60 tolock the end effector 100 in place (to fix the X-Y and Y-Z orientations)to create a single position, rigid surgical tool 10. After navigatingthe LAA occlusion clip 102 proximate the LAA, the occlusion clip isopened prior to deployment on the LAA.

Opening the LAA occlusion clip 102 is carried out by actuating the levercontrol 80. In particular, the handle 1350 is pivotally repositionedtoward the housings 1000, 1002, which is operative to tension thecontrol wire 1364 and cause the end effector 100 to further separate itsjaws 240, 250 from one another and open the clip 102. More specifically,tensioning the control wire 1364 is operative to reposition the pulley220 proximally. Because a respective cylindrical lateral end of thepulley 220 is received in a through opening 646 of a respective toggle200, 210, when the pulley 220 is repositioned proximally, so too are thetoggles repositioned proximally (toward the universal 120) as well asrotating about an axis extending through the opening 646. In particular,the proximal motion and rotation of the toggles 200, 210 operates topush against the first and second drive links 140, 150 via the ninth andtenth pins 310, 320 causing the drive links to move away from oneanother. But the connection between the first and second drive links140, 150 and the linkage housing 130, via the first pin 160, causes thedrive links to pivot with respect to the linkage housing about the firstpin when the drive links are attempted to be moved away from one anothervia the motion of the toggles 200, 210.

The pivoting motion of the drive links 140, 150 is transferred to thejaws 240, 250 via the connection therebetween, facilitated by the fifthand sixth pins 260, 270. More specifically, the pivoting of the drivelinks 140, 150 away from one another causes the jaws 240, 250 to moveaway from one another. But the movement of the jaws 240, 250 away fromone another is constrained by the connection of the jaws to the firstand second parallel links 180, 190, which are themselves pivotallymounted to the linkage housing 130. The additional constraint offered bythe parallel links 180 results in motion of the jaws 240, 250 thatmaintains the jaws in a generally parallel relationship as the jaws aremoved from a closed position (adjacent one another with spacing toaccommodate the clip 102) to a fully open position (spaced away from oneanother to open the clip to a predetermined maximum extent necessary toposition the clip on a LAA). This fully open position of the jaws 240,250 coincides with the surface of the toggle connector portions 640contacting the first and second surfaces 582, 584 of the inner arms 534,536, thus stopping further proximal and pivoting motion of the toggles200, 210. In other words, the inner arms 534, 536 of the linkage housing130 operate to limit the travel of the toggles 200, 210, thereby settingthe maximum spacing between the jaws 240, 250 in a fully open position(see FIG. 2).

As long as the jaws 240, 250 are attached to the occlusion clip 102, themotion of the jaws results in corresponding motion of the occlusionclip. More specifically, when the jaws are in a closed position (seeFIG. 1) and mounted to the occlusion clip 102, the bias of the occlusionclip retains the jaws in the closed position. But when one wants to openthe occlusion clip 102 in anticipation of positioning the clip around aLAA, the user of the device 10 must overcome the bias of the occlusionclip. In order to do this, the device 10 incorporates structures thatprovide a mechanical advantage allowing the user to pivot the handle1350 toward the housings 1000 and tension the control wire 1364, whichas discussed in greater detail previously, ultimately causing the jaws240, 250 to separate from one another and correspondingly separate theparallel beams of the occlusion clip 102 from one another.

Post opening of the LAA occlusion clip 102, the clip is advanced overthe distal tip of the LAA with the LAA passing between correspondingocclusion beams of the clip, stopping only upon reaching the base of theLAA. It should be noted that forceps may be used to grasp a portion ofthe LAA when positioning the LAA occlusion clip 102. After the clip 102has been positioned at the base of the LAA, with the LAA interposingcorresponding occlusion beam surfaces of the clip, the user of thesurgical tool 10 may close the clip 102 to sandwich the LAA between theocclusion surfaces.

Closing the LAA occlusion clip 102 is also carried out by actuating thelever control 80. Specifically, the user depresses the trigger 1352 toallow the handle 1352 (which is biased to move away from the housings1000, 1002) to reposition away from the housings 1000, 1002 andthereafter guide the handle away from the housings. By repositioning thehandle 1352 away from the housings 1000, 1002, the control wire 1364 isrepositioned and facilitates the jaws 240, 250 of the end effector 100moving closer to one another (from the bias of the clip 102 while theclip is mounted to the end effector 100), thereby sandwiching the cliparound the LAA. More specifically, by repositioning the handle 1352 awayfrom the housings 1000, 1002, the tension on the control wire 1364 islessened.

Lessening the tension of the control wire 1364 causes the end effector100 to reposition its jaws 240, 250 toward one another, which coincideswith closing the occlusion clip 102. More specifically, lessening thetension of the control wire 1364 allows the bias of the occlusion clip102 to become the dominant force and reposition the jaws 240, 250 towardone another. In exemplary form, the dominant biasing force of theocclusion clip 102 is operative to reposition the jaws 240, 250, whichin turn causes the first and second drive links 140, 150 to pivot towardone another, coinciding with the parallel links 180, 190 pivoting towardone another. Likewise, the toggles 200, 210 are pivoted and repositioneddistally, as is the pulley 220, ultimately leading to the componentpositions shown in FIG. 1.

After the occlusion clip 102 is positioned about the LAA, various stepsmay be undertaken to ensure the entire periphery of a portion of LAA issandwiched by the clip 102 such as, without limitation, direct visualverification and utilization of a transesophageal echocardiogram. If anyproblems are determined with respect to the clip 102 placement, theopening and closing clip sequence may be repeated to adjust thepositioning of the clip with respect to the LAA. Upon closing the LAAocclusion clip 102 around a periphery of a portion of the LAA, proximatethe LAA base, as well as confirming the placement of the closed clipbeing operative to occlude the LAA, the surgeon may release theocclusion clip from the end effector 100.

To release the clip 102 from the end effector 100, the user removes therepositionable tab 70 from the proximal end of the user control 20. Thisremoval of the repositionable tab 70 causes the deployment wires 1402,1404 to be repositioned proximally and discontinue engagement with thesuture loops 1412. When the engagement with the suture loops 1412 isdiscontinued, the occlusion clip 102 is no longer fastened to the jaws240, 250 (i.e., the jaws can be opened and closed without repositioningthe clip). As discussed previously, the repositionable tab 70 may bewithdrawn from the user control 20 in a straight pull fashion byovercoming a friction fit force or may be withdrawn via other movementsincluding, without limitation, rotation and a combination of rotationand a straight pull that may make use of threads or detents. Afterdisengagement between the occlusion clip 102 and the end effector 100,the end effector is removed from the cardiac space.

Removal of the end effector 100 from the patient's body is controlled bythe user. Because the end effector 100 is open-ended, there is no needto reposition the end effector upward along the LAA because the endeffector can be withdrawn laterally, thus reducing the potential forcontact between the end effector and the LAA. In other words, the endeffector 100 may be removed from around the LAA without having a tip ofthe LAA passing between the jaws 240, 250. As part of removing the endeffector 100 from the cardiac and thoracic space, the user manipulatesthe user control 20 and causes repositioning of the end effector 100 toallow withdrawal from the patient's body cavity via the incision ortrocar. By way of example, it is envisioned that the user repositionsthe first and second wheel controls 40, 50 in order to longitudinallyalign the end effector 100 with the shaft assembly 30 prior to removingthe end effector through the trocar or incision.

Following from the above description and invention summaries, it shouldbe apparent to those of ordinary skill in the art that, while themethods and apparatuses herein described constitute exemplaryembodiments of the present invention, it is to be understood that theinventions contained herein are not limited to the above preciseembodiment and that changes may be made without departing from the scopeof the invention as defined by the following proposed points of novelty.Likewise, it is to be understood that it is not necessary to meet any orall of the identified advantages or objects of the invention disclosedherein in order to fall within the scope of the invention, sinceinherent and/or unforeseen advantages of the present invention may existeven though they may not have been explicitly discussed herein.

What is claimed is:
 1. A method of establishing controls for an endeffector of a medical instrument, the medical instrument including ahand-held device operatively coupled to the end effector, the methodcomprising: providing a first manual control of the hand-held deviceconfigured to direct repositioning of at least one of a first member anda second member of a first joint of the end effector, the first memberand second member being repositionable with respect to one another in afirst degree of freedom; providing a second manual control of thehand-held device configured to direct repositioning of at least one of athird member and a fourth member of a second joint of the end effector,the third member and fourth member being repositionable with respect toone another in a second degree of freedom different from the firstdegree of freedom; and, providing a third manual control of thehand-held device configured to direct repositioning of a foldingpantograph support between a compact position and an expanded position,the folding pantograph support operatively coupled to the first andsecond joints.
 2. The method of claim 1, further including providing afourth control of the hand-held device configured to selectivelydisengage an occlusion clip operatively coupled to the foldingpantograph support.
 3. The method of claim 1, wherein: the first controlincludes a first wheel having a first wire partially wound therearound,where the first wire is also operatively coupled to at least one of thefirst member and the second member of the first joint of the endeffector; and, the second control includes a second wheel having asecond wire partially wound therearound, where the second wire is alsooperatively coupled to at least one of the third member and the fourthmember of the second joint of the end effector.
 4. The method of claim1, wherein the third control includes a repositionable handleoperatively coupled to the hand-held device, the repositionable handleoperatively coupled to a wire that is operatively coupled to the foldingpantograph support to allow repositioning of the folding pantographsupport between the compact position and the expanded position.
 5. Amethod of establishing controls for an end effector of a medicalinstrument, the medical instrument including a hand-held deviceoperatively coupled to the end effector, the method comprising:providing a first manually actuated control of the hand-held deviceremote from the end effector and configured to direct repositioning ofat least one of a first member and a second member of a first joint ofthe end effector, the first member and second member beingrepositionable with respect to one another in a first degree of freedom;providing a second manually actuated control of the hand-held deviceremote from the end effector and configured to direct repositioning ofat least one of a third member and a fourth member of a second joint ofthe end effector, the third member and fourth member beingrepositionable with respect to one another in a second degree of freedomdifferent from the first degree of freedom; and, providing a thirdmanually actuated control of the hand-held device remote from the endeffector and configured to direct repositioning of a folding supportbetween a compact position and an expanded position, the folding supportoperatively coupled to the first and second joints; providing a fourthmanually actuated control of the hand-held device remote from the endeffector and configured to selectively disengage an occlusion clipoperatively coupled to the folding support.
 6. The method of claim 5,wherein: the first manually actuated control includes a first wheelhaving a first wire partially wound therearound, where the first wire isalso operatively coupled to at least one of the first member and thesecond member of the first joint of the end effector; and, the secondmanually actuated control includes a second wheel having a second wirepartially wound therearound, where the second wire is also operativelycoupled to at least one of the third member and the fourth member of thesecond joint of the end effector.
 7. The method of claim 5, wherein thethird manually actuated control includes a repositionable handleoperatively coupled to the hand-held device, the repositionable handleoperatively coupled to a wire that is operatively coupled to the foldingsupport to allow repositioning of the folding support between thecompact position and the expanded position.
 8. A method of establishingcontrols for an end effector of a medical instrument, the medicalinstrument including a hand-held device operatively coupled to the endeffector, the method comprising: providing a first manually actuatedcontrol of the hand-held device remote from the end effector andconfigured to direct repositioning of at least one of a first member anda second member of a first joint of the end effector, the first memberand second member being repositionable with respect to one another in afirst degree of freedom; providing a second manually actuated control ofthe hand-held device remote from the end effector and configured todirect repositioning of at least one of a third member and a fourthmember of a second joint of the end effector, the third member andfourth member being repositionable with respect to one another in asecond degree of freedom different from the first degree of freedom;and, providing a third manually actuated control of the hand-held deviceremote from the end effector and configured to direct repositioning of afolding support between a compact position and an expanded position, thefolding support operatively coupled to the first and second joints;wherein the first manually actuated control includes a first wheelhaving a first wire partially wound therearound, where the first wire isalso operatively coupled to at least one of the first member and thesecond member of the first joint of the end effector; wherein the secondmanually actuated control includes a second wheel having a second wirepartially wound therearound, where the second wire is also operativelycoupled to at least one of the third member and the fourth member of thesecond joint of the end effector.
 9. The method of claim 8, furtherincluding providing a fourth manually actuated control of the hand-helddevice remote from the end effector and configured to selectivelydisengage an occlusion clip operatively coupled to the folding support.10. The method of claim 8, wherein the third manually actuated controlincludes a repositionable handle operatively coupled to the hand-helddevice, the repositionable handle operatively coupled to a wire that isoperatively coupled to the folding support to allow repositioning of thefolding support between the compact position and the expanded position.